Pulmonary Procedures |

Tracheal Perforation by an Anterior Cervical Fixation Device FREE TO VIEW

Anand Pariyadath, MD; Vikas Pathak, MBBS; Samira Shojaee, MD
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Virginia Commonwealth University Health System, Richmond, VA

Chest. 2015;148(4_MeetingAbstracts):839A. doi:10.1378/chest.2252913
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SESSION TITLE: Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Anterior cervical spine fusion is an effective method for stabilizing injuries of the cervical spine. Serious complications involving migration of the hardware as well as tracheal injury during surgery and in the perioperative period have been described; however, we report a rare case of tracheal perforation related to cervical hardware.

CASE PRESENTATION: A 34-year-old woman hospitalized for MRSA-bacteremia and a C2-T2 epidural abscess was found to have a metallic object on a chest x-ray obtained while undergoing rehabilitation. She was status post surgical drainage of the epidural abscess and anterior cervical disc fusion with anterior cervical plate placement. On chest CT, in addition to the foreign body in the posterior segment of her right lower lobe, she appeared to have distal anterior cervical plate detachment, resulting in protrusion of the hardware through the posterior membrane of her trachea. She was taken to the operating room for management of a critically unstable cervical spine and tracheal perforation. After intubation, the tracheal injury was visualized by flexible bronchoscopy at the level of tracheal rings 3-4 with the hardware visible through the posterior membrane of the tracheal wall. The endotracheal tube was advanced to bypass this area to prevent pneumothorax on mechanical ventilation. The cervical hardware was removed by Orthopedics and noted to have a missing screw. Otolaryngology fixed the tracheal injury with a muscle flap, and bronchoscopic inspection of the trachea showed no air leak. The missing screw was retrieved via bronchoscopy using a 2.0mm jaw forceps. Five days later, posterior fusion was performed and follow-up bronchoscopy showed satisfactory healing of the posterior membrane. The patient was extubated within the next few days.

DISCUSSION: Anterior cervical plates are used for cervical discectomy and fusion to increase spine stability following surgery. Most complications involving loosened screws or plates can be managed conservatively. More serious injuries involving erosions of the hardware through anterior structures can rarely occur. To our knowledge, this is the first reported case of tracheal perforation related to a cervical plate.

CONCLUSIONS: Although a rare complication, tracheal injury due to cervical hardware should be considered in patients that develop respiratory symptoms in the post-operative period.

Reference #1: Kuo Y, Levine M. Erosion of Anterior Cervical Plate into Pharynx with Pharyngotracheal Fistula. Dysphagia 2010; 334-7.

DISCLOSURE: The following authors have nothing to disclose: Anand Pariyadath, Vikas Pathak, Samira Shojaee

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