Migration of spinal pedicle screw with aerodigestive perforation and subsequent device expectoration

INTRODUCTION: Spinal fixation is a common surgical procedure. Frequently, fixation for spinal stabilization requires use of instrumentation such as pedicle screws and fixation plates. Aerodigestive and vascular perforations from such procedures are infrequent albeit known complications from these procedures. PRESENTATION OF CASE: This case details an uncommon situation in which a patient with anterior cervical spine fixation in the distant past was found to have a migratory pedicle screw. The patient had symptoms of neck pain and dysphagia. Radiographic studies were helpful in demonstrating the problem. While undergoing a physical examination, the patient was witnessed to expectorate the screw. Further work up with panendoscopy was undertaken and the patient managed conservatively. DISCUSSION: The upper aerodigestive system rarely experiences perforation from spinal stabilization hardware. When it occurs, management should include a dedicated investigation of the involved portions of the digestive system to avoid further complication. CONCLUSION: This case presents an rare occurrence of aerodigestive perforation of a spinal pedicle screw which was self-removed.