The untold story of a coughed-out screw: a case report

Abstract

A 70 years old male, case of Cervical Spondylotic Myelopathy (C3-C4, C4-C5) with complaints of difficulty in walking and weakness of upper and lower limbs for 6 months presented to the outdoor department. Patient had restricted and painful movements of cervical spine. Patient was evaluated and then operated for anterior cervical discectomy and fusion with bone grafting at C3-C4, C4-C5. After first surgery the, Pre-op VAS Score improved from 8 to 2 and the Nurick Score improved from grade 4 pre op to grade 2 postop. Once the union of graft appeared adequate, we tried to convince the patient for early removal of prominent and prouting implant as the proximal screws were backing out but patient refused surgery. He finally presented with a coughed-out screw in his mouth in emergency. After removal of implant the surgical wound healed well and he did not complaint of any difficulty in deglutition. Loosening of implants after anterior cervical spine fusion surgeries adds to the morbidity to the procedure. Proper sized low-profile implants with good locking mechanism can reduce the complication rates. Adequate pre-operative planning is a must for successful outcome of cervical spine surgeries.