Page 102 - Portuguese Journal - SPORL - Vol 61. Nº2

Figures 7 and 8
Lateral cervical spine X-ray and cervical computed tomography sagittal reformat performed seven days
after the removal of the screw without evidence of any complications

Discussion The most frequent cause of pharyngeal
There are few reports in the literature about perforation after anterior cervical spine
the migration of screws used in cervical surgery is the migration of the osteosynthesis
spine osteosynthesis and consequent late material. In such cases, several factors can
1,6
perforation of the pharynx with subsequent precipitate this migration, with the most
extrusion through the oral cavity. 2,4–7 As frequent being its inadequate insertion, 2,4,6
the complications can have devastating which is more common in perforations
consequences, there are few reports of patients occurring in the peri- and immediate
with mild symptoms, complete resolution with postoperative periods. Other precipitating
conservative treatment, and those without factors include faulty material, excessive
significant associated morbidity. 4–7 Based on cervical spine mobilization, congenital
the literature review, this is the first report anomalies of the spine, osteoporosis, and local
of a clinical case with such a long interval infection. The causes of late perforation of
2,9
(30 years) between cervical spine surgery the pharynx are as follows: compression of the
and perforation of the pharynx because of osteosynthesis material against the posterior
the migration and subsequent extrusion of wall of the pharynx resulting in ischemia,
an osteosynthesis screw. Given the rarity of necrosis, and consequent perforation, 1,2,6,7 as
late perforation of the pharynx, its incidence well as diseases that weaken the muscles.
10
has not yet been reported. The frequency of As our patient did not have imaging signs
pharyngoesophageal perforation reported in of congenital spinal disease, osteoporosis,
the literature is 0.25%, corresponding in most infection, or a history of pharyngoesophageal
cases to esophageal perforation. or cervical disease, we assumed that the most
8
Pharyngeal perforation usually occurs in the probable cause was material migration due to
early postoperative period or, exceptionally, cervical movement over several years.
late after surgery, up to approximately ten Although the mechanisms suggested for
years after surgical intervention. pharyngeal and esophageal perforations are
3

244 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery