Screw loosening and subsequent expectoration without anatomical defect following anterior cervical discectomy and fusion for cervical myelopathy: illustrative case.

backgroundAnterior 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. OBSERVATIONS: 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 C5-6 and C6-7 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. LESSONS: 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. https://thejns.org/doi/10.3171/CASE24340.