{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:38:16Z","timestamp":1771234696997,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"14","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,7]]},"abstract":"\n BACKGROUND<\/jats:title>\n Anterior cervical discectomy and\/or corpectomy with fusion is a standard treatment approach for cervical myelopathy and radiculopathy caused by anterior degenerative and compressive pathology. Serious complications are rare, but esophageal and pharyngeal injuries relating to anterior cervical operations can cause significant morbidity and mortality. The authors present the case of delayed anterior plate screw loosening with eventual expectoration of a screw without anatomical defect.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 52-year-old male presented to the neurosurgery clinic with cervical myeloradiculopathy. He had severe cervical stenosis with associated myelomalacia. Conservative management failed, and the patient underwent C4 corpectomy and C5\u20136 and C6\u20137 anterior cervical discectomy and fusion (ACDF) with anterior plating. He experienced backing out of some of his screws, refused revision, and eventually expectorated his right C3 screw 14 months after surgery with minimal symptoms. He showed no anatomical defects on evaluation and experienced no major morbidity.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Hardware expectoration is a rare complication of ACDF. The lack of an esophageal or laryngeal defect could possibly be explained by gradual healing of the injury given the chronicity of his problem. A patient with screw loosening after ACDF should be carefully monitored and evaluated postoperatively due to the potential for significant morbidity and mortality from screw migration and expectoration.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24340<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24340","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T11:01:27Z","timestamp":1744023687000},"source":"Crossref","is-referenced-by-count":2,"title":["Screw loosening and subsequent expectoration without anatomical defect following anterior cervical discectomy and fusion for cervical myelopathy: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4023-7179","authenticated-orcid":true,"given":"Nisha L.","family":"Busch","sequence":"first","affiliation":[{"name":"College of Medicine, Drexel University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Zaki","sequence":"additional","affiliation":[{"name":"College of Medicine, Drexel University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Bolger","sequence":"additional","affiliation":[{"name":"College of Medicine, Drexel University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5716-2041","authenticated-orcid":true,"given":"Nathan","family":"Esplin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cody","family":"Woodhouse","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung W.","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahed","family":"Elhamdani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1582-7938","authenticated-orcid":true,"given":"Alexander","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"207","article-title":"Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study","volume":"43","author":"Buttermann","year":"2018","unstructured":"Buttermann GR.Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study. Spine (Phila Pa 1976). 2018;43(3):207-214."},{"issue":"3","key":"bib2","series-title":"Neurospine","first-page":"408","article-title":"Anterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations","volume":"16","author":"Deora","year":"2019","unstructured":"Deora HKim SHBehari SAnterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations. Neurospine. 2019;16(3):408-420."},{"issue":"12","key":"bib3","series-title":"Spine (Phila Pa 1976)","first-page":"E675","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","unstructured":"Nouri ATetreault LSingh AKaradimas SKFehlings MG.Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976). 2015;40(12):E675-E693."},{"key":"bib4","series-title":"Surg Neurol Int","first-page":"100","article-title":"A review of complication rates for anterior cervical diskectomy and fusion (ACDF)","volume":"10","author":"Epstein","year":"2019","unstructured":"Epstein NE.A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int. 2019;10:100."},{"issue":"1","key":"bib5","series-title":"J Spine Surg","first-page":"302","article-title":"Complications of anterior cervical spine surgery: a systematic review of the literature","volume":"6","author":"Yee","year":"2020","unstructured":"Yee TJSwong KPark P.Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg. 2020;6(1):302-322."},{"issue":"3","key":"bib6","series-title":"J Spinal Disord Tech","first-page":"199","article-title":"Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating","volume":"19","author":"Fountas","year":"2006","unstructured":"Fountas KNKapsalaki EZMachinis TRobinson JS.Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating. J Spinal Disord Tech. 2006;19(3):199-203."},{"issue":"16","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"1814","article-title":"Oral extrusion of a screw after anterior cervical spine plating","volume":"26","author":"Geyer","year":"2001","unstructured":"Geyer TEFoy MA.Oral extrusion of a screw after anterior cervical spine plating. Spine (Phila Pa 1976). 2001;26(16):1814-1816."},{"issue":"1","key":"bib8","series-title":"BMC Surg","first-page":"22","article-title":"Oral extrusion of a vertebral body replacement device after chordoma tumor growth and radiation: case report and review","volume":"22","author":"Guti\u00e9rrez-Gonz\u00e1lez","year":"2022","unstructured":"Guti\u00e9rrez-Gonz\u00e1lez RZamarr\u00f3n \u00c1Ortega CHamre FKalantari TRodr\u00edguez-Boto G.Oral extrusion of a vertebral body replacement device after chordoma tumor growth and radiation: case report and review. BMC Surg. 2022;22(1):22."},{"issue":"2","key":"bib9","series-title":"J Spine Surg","first-page":"218","article-title":"Expectoration of anterior cervical discectomy and fusion cage: a case report","volume":"7","author":"Prusick","year":"2021","unstructured":"Prusick PJSabri SAKleck CJ.Expectoration of anterior cervical discectomy and fusion cage: a case report. J Spine Surg. 2021;7(2):218-224."},{"issue":"5","key":"bib10","series-title":"J Neurosurg Spine","first-page":"560","article-title":"A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct","volume":"26","author":"Quadri","year":"2017","unstructured":"Quadri SACapua JRamakrishnan VA rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct. J Neurosurg Spine. 2017;26(5):560-566."},{"issue":"3","key":"bib11","series-title":"J Neurosurg Spine","first-page":"285","article-title":"Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature","volume":"25","author":"Halani","year":"2016","unstructured":"Halani SHBaum GRRiley JPEsophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine. 2016;25(3):285-291."},{"issue":"6","key":"bib12","series-title":"Spine","first-page":"670","article-title":"Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review","volume":"25","author":"Sampath","year":"2000","unstructured":"Sampath PBendebba MDavis JDDucker TB.Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine. 2000;25(6):670-676."},{"issue":"1","key":"bib13","series-title":"Glob Spine J","first-page":"40S","article-title":"Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery","volume":"7","author":"Smith","year":"2017","unstructured":"Smith GAPace JCorriveau MIncidence and outcomes of acute implant extrusion following anterior cervical spine surgery. Glob Spine J. 2017;7(1suppl):40S-45S."},{"issue":"1","key":"bib14","series-title":"Oper Neurosurg (Hagerstown)","first-page":"8","article-title":"Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients","volume":"20","author":"Tatter","year":"2020","unstructured":"Tatter CPersson OBurstr\u00f6m GEdstr\u00f6m EElmi-Terander A.Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients. Oper Neurosurg (Hagerstown). 2020;20(1):8-17."},{"issue":"4","key":"bib15","series-title":"Ann Thorac Surg","first-page":"1475","article-title":"Evolving options in the management of esophageal perforation","volume":"77","author":"Brinster","year":"2004","unstructured":"Brinster CJSinghal SLee LMarshall MBKaiser LRKucharczuk JC.Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475-1483."},{"issue":"7","key":"bib16","series-title":"Cureus","first-page":"e63651","article-title":"The management of esophageal perforation: a systematic review","volume":"16","author":"Shaqran","year":"2024","unstructured":"Shaqran TMEngineer RAbdalla EMThe management of esophageal perforation: a systematic review. Cureus. 2024;16(7):e63651."},{"issue":"3","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"207","article-title":"Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study","volume":"43","author":"Buttermann","year":"2018","unstructured":"Buttermann GR.Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study. Spine (Phila Pa 1976). 2018;43(3):207-214."},{"issue":"3","key":"bib2","series-title":"Neurospine","first-page":"408","article-title":"Anterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations","volume":"16","author":"Deora","year":"2019","unstructured":"Deora HKim SHBehari SAnterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations. Neurospine. 2019;16(3):408-420."},{"issue":"12","key":"bib3","series-title":"Spine (Phila Pa 1976)","first-page":"E675","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","unstructured":"Nouri ATetreault LSingh AKaradimas SKFehlings MG.Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976). 2015;40(12):E675-E693."},{"key":"bib4","series-title":"Surg Neurol Int","first-page":"100","article-title":"A review of complication rates for anterior cervical diskectomy and fusion (ACDF)","volume":"10","author":"Epstein","year":"2019","unstructured":"Epstein NE.A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int. 2019;10:100."},{"issue":"1","key":"bib5","series-title":"J Spine Surg","first-page":"302","article-title":"Complications of anterior cervical spine surgery: a systematic review of the literature","volume":"6","author":"Yee","year":"2020","unstructured":"Yee TJSwong KPark P.Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg. 2020;6(1):302-322."},{"issue":"3","key":"bib6","series-title":"J Spinal Disord Tech","first-page":"199","article-title":"Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating","volume":"19","author":"Fountas","year":"2006","unstructured":"Fountas KNKapsalaki EZMachinis TRobinson JS.Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating. J Spinal Disord Tech. 2006;19(3):199-203."},{"issue":"16","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"1814","article-title":"Oral extrusion of a screw after anterior cervical spine plating","volume":"26","author":"Geyer","year":"2001","unstructured":"Geyer TEFoy MA.Oral extrusion of a screw after anterior cervical spine plating. Spine (Phila Pa 1976). 2001;26(16):1814-1816."},{"issue":"1","key":"bib8","series-title":"BMC Surg","first-page":"22","article-title":"Oral extrusion of a vertebral body replacement device after chordoma tumor growth and radiation: case report and review","volume":"22","author":"Guti\u00e9rrez-Gonz\u00e1lez","year":"2022","unstructured":"Guti\u00e9rrez-Gonz\u00e1lez RZamarr\u00f3n \u00c1Ortega CHamre FKalantari TRodr\u00edguez-Boto G.Oral extrusion of a vertebral body replacement device after chordoma tumor growth and radiation: case report and review. BMC Surg. 2022;22(1):22."},{"issue":"2","key":"bib9","series-title":"J Spine Surg","first-page":"218","article-title":"Expectoration of anterior cervical discectomy and fusion cage: a case report","volume":"7","author":"Prusick","year":"2021","unstructured":"Prusick PJSabri SAKleck CJ.Expectoration of anterior cervical discectomy and fusion cage: a case report. J Spine Surg. 2021;7(2):218-224."},{"issue":"5","key":"bib10","series-title":"J Neurosurg Spine","first-page":"560","article-title":"A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct","volume":"26","author":"Quadri","year":"2017","unstructured":"Quadri SACapua JRamakrishnan VA rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct. J Neurosurg Spine. 2017;26(5):560-566."},{"issue":"3","key":"bib11","series-title":"J Neurosurg Spine","first-page":"285","article-title":"Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature","volume":"25","author":"Halani","year":"2016","unstructured":"Halani SHBaum GRRiley JPEsophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine. 2016;25(3):285-291."},{"issue":"6","key":"bib12","series-title":"Spine","first-page":"670","article-title":"Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review","volume":"25","author":"Sampath","year":"2000","unstructured":"Sampath PBendebba MDavis JDDucker TB.Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine. 2000;25(6):670-676."},{"issue":"1","key":"bib13","series-title":"Glob Spine J","first-page":"40S","article-title":"Incidence and outcomes of acute implant extrusion following anterior cervical spine surgery","volume":"7","author":"Smith","year":"2017","unstructured":"Smith GAPace JCorriveau MIncidence and outcomes of acute implant extrusion following anterior cervical spine surgery. Glob Spine J. 2017;7(1suppl):40S-45S."},{"issue":"1","key":"bib14","series-title":"Oper Neurosurg (Hagerstown)","first-page":"8","article-title":"Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients","volume":"20","author":"Tatter","year":"2020","unstructured":"Tatter CPersson OBurstr\u00f6m GEdstr\u00f6m EElmi-Terander A.Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients. Oper Neurosurg (Hagerstown). 2020;20(1):8-17."},{"issue":"4","key":"bib15","series-title":"Ann Thorac Surg","first-page":"1475","article-title":"Evolving options in the management of esophageal perforation","volume":"77","author":"Brinster","year":"2004","unstructured":"Brinster CJSinghal SLee LMarshall MBKaiser LRKucharczuk JC.Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475-1483."},{"issue":"7","key":"bib16","series-title":"Cureus","first-page":"e63651","article-title":"The management of esophageal perforation: a systematic review","volume":"16","author":"Shaqran","year":"2024","unstructured":"Shaqran TMEngineer RAbdalla EMThe management of esophageal perforation: a systematic review. 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