Videofluorography and MDCT findings in a case of pharyngeal perforation after anterior cervical spinal surgery with fusion (ACSF)

Purpose Anterior cervical spinal surgery with fusion (ACSF) is the most widely usedtechnique in the management of cervical spondylosis or disc herniation. A case ofpharyngeal perforation after ACSF demonstrated by videofluorography and MDCT isdescribed.Methods A 39-year-old man, recently undergone to ACSF for interbody C3-C5 fusion withanterior cervical plate and screws, was submitted to a pharingoesophagealvideofluorography and 64 row-MDCT of the neck before and after oral administration ofiodine contrast medium for persistent high dysphagia.Results In the plain radiograph a fractured screw was detected, anterolaterally displacedon the right to the cervical spine, outside the pharingeal lumen. After high-density (250%weight/volume) barium suspension administration the screw floated outside the pharingeallumen at C4-C6 level, and an extraluminal leak of barium was observed. On CT MPR and3D reformatted images confirmed the screw was fractured and displaced outside the platein the retropharingeal space, anteriorly to C4, and also the hypothesis of posteriorpharingeal wall damage, for the presence of gas bubbles in the retropharingeal space,thickening of prevertebral soft tissues, and contrast medium leak through a pharyngealbreak in the retropharingeal space.Conclusions Imaging can play a role to correctly address the cause of disphagya afterACSF.