Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte.

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

An Assessment of the Medial Angle of Inserted Subaxial Cervical Pedicle Screw during Surgery: Practical Use of Preoperative CT Scanning and Intraoperative X-rays.

The most important factor for cervical pedicle screw placement (CPS) is creating a sufficient medial angle. We aimed to know the medial angle of the inserted subaxial CPS during surgery using intraoperative AP X-rays. From March 2012 to September 2014, we performed posterior cervical fusions using CPS on 75 patients, including a total of 389 CPS insertions. Using preoperative CT scanning, we determined the θlat (i.e., an angle between a vertical line and a line to connect the planned entry point and the axial middle point of the pedicle) and θmed (i.e., an angle between a vertical line and a line to connect a new medial entry point and the axial middle point of the pedicle; this angle was regarded as minimally acceptable and a safe medial angle). The actual inserted medial angle (θins) was checked and we determined whether it was between the θmed and θlat in the accurately placed CPS, and not in the laterally violated CPS. We measured the horizontal distance of the CPS body (l; using an intraoperative AP X-ray). If the actual screw length (L) was known, we could calculate the medial angle (θAP) as sin-1 l / L. We checked the θAP and θins for all of the same levels. Intra- and inter-observer agreement was analyzed. Among 368 accurately inserted CPSs, we found that 360 of the θins values were greater than or equal to the θmed on the same level (P <0.001). The intra-observer agreements were 0.781 and 0.847. The inter-observer agreements were 0.917 and 0.949. It was important that θins was greater than or equal to the θmed. Our suggested formula, θAP = sin-1 l / L, seems to be useful for predicting the medial angle of the inserted CPS and for comparing it with θmed during surgery based on an AP X-ray and preoperative CT scan.

Can an Anchored Cage be Substituted for an Anterior Cervical Plate and Screw for Single-Level Anterior Cervical Fusion Surgery?: Prediction of Poor Candidates Through a Review of Early Clinical and Radiologic Outcomes.

STUDY DESIGN: This is a case series of device failure patients. OBJECTIVE: To identify poor candidates for anterior cervical discectomy and fusion (ACDF) using an anchored cage. SUMMARY OF BACKGROUND DATA: An anchored cage has been used as an alternative implant for ACDF surgery because of ease of use, relatively acceptable fusion rate, and lower risk of plate-related complications, including dysphagia. MATERIALS AND METHODS: We retrospectively reviewed the outcomes of 36 patients who underwent ACDF using an anchored cage between January 2012 and December 2013. The initial diagnoses included 8 traumatic soft disk herniations without posterior ligamentous complex injury, 25 degenerative soft disk herniations, 1 degenerative foraminal stenosis, 1 traumatic soft disk herniation after reducing a unilaterally dislocated facet joint, and 1 subluxation of a previously implanted cervical artificial disk. We encountered 5 cases with poor outcomes and performed 3 revisions on the index level. We reviewed the clinical and radiologic data for 31 patients with reasonable outcomes and reviewed the failed 5 cases separately. RESULTS: Among the 31 patients with reasonable outcomes, all the clinical parameters improved. For the radiologic outcomes, 10 cases of cage subsidence occurred and no patient experienced instability.Among the 5 patients with poor outcomes, 1 patient had traumatic soft disk herniation and a reduced unilaterally dislocated facet joint, 1 patient had subluxation of a previously implanted cervical artificial disk, and 3 patients had degenerative soft disk herniation and poor bone quality. Although 3 patients required revision surgeries, 2 patients showed only radiologic failures without revision. CONCLUSIONS: We analyzed the short-term outcomes of ACDF using an anchored cage and observed 5 patients with poor outcomes among 36 patients. We recommend the use of a single anchored cage for patients with definite evidence of posterior column stability and healthy bone. LEVEL OF EVIDENCE: Level 3.