Retropharyngeal granulation: A delayed complication of anterior cervical discectomy and fusion in C2-3.

Retropharyngeal granulation: A delayed complication of anterior cervical discectomy and fusion in C2-3.

World Neurosurg. 2019 Feb 05;:

Authors: Kim JH, Lee SK, Hong JH, Moon BJ, Lee JK

Abstract
INTRODUCTION: A 26-year-old man presented with acute quadriparesis owing to a traffic accident. A computed tomography scan revealed a hangman fracture and locking of the left facet joint at C2-3. Magnetic resonance imaging showed a high signal change of the spinal cord on T2-weighted image and hemorrhage in the C2-3 level. An emergency closed reduction after anterior cervical discectomy and fusion were performed for spinal stability and decompression of the dural sac. Five months postoperatively, C1-2-3 posterior wiring using an iliac bone graft with Brook's method was performed due to non-union of C2-3. After using the posterior cervical approach, the patient began complaining about the difficulty in swallowing. A 5 × 2 × 1-cm-sized posterior pharyngeal wall mass was detected on an endoscopic examination. Despite conservative management, the retropharyngeal mass progressed and dysphagia worsened, so the retropharyngeal wall granulation mass was resected by a laryngologist. Despite removal of the granulation mass, dysphagia and throat discomfort persisted for about 2 years. The plate and screws were removed considering their possible correlation with the granulation tissue. One month after plate removal, the retropharyngeal granulation tissue resolved almost spontaneously. At the last follow-up, the radiological examination showed well-fused C1-2-3 with good alignment. The patient had no residual neurological deficits or dysphagia.
CONCLUSION: Retropharyngeal granulation can occur as a late complication associated with plate fixation following anterior cervical discectomy and fusion. Recurrent retropharyngeal wall granulation caused by plate irritation might only be resolved after plate and screw removal.

PMID: 30735876 [PubMed - as supplied by publisher]

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