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Study Design: Case report and clinical discussion. Objective: To describe a rare case of spinal cervical screw migration into the gastrointestinal tract 11 years after surgery. Summary Of Background Data: Anterior cervical spine fusion and stabilization with plating is a well-established procedure for cervical myelopathy, cervical spinal trauma, and spinal infectious disease. Esophageal injury has been related to screw or plate extrusion. Methods: We present a 45-year-old white man suffering from severe quadriparesis and neck pain. Cervical spine magnetic resonance images showed spondylodiscitis and spinal fracture of C4 and C5 vertebral bodies. He underwent anterior surgical decompression consisting of C4 and C5 corpectomies and fusion with fibular allograft fixated with a cervical plate. The patient's neurologic examination gradually improved during his follow-up. Results: The patient returned 11 years after cervical spine graft and plating, complaining of severe dysphagia and high fever. Radiographs of the cervical spine showed a screw back-out. Three days later, a new radiograph of the cervical spine revealed a progression of the screw's extrusion. In a new cervical spine radiograph, obtained immediately before surgical intervention, the displaced screw was no more visible. Abdominal radiograph showed the missed screw in the right lower abdominal quadrant. Barium meal swallowing test showed no leakage on the cervical area. At 6 months follow-up, the patient is in good condition and symptom free. Conclusion: In this case, the delayed esophageal perforation occurred 11 years after initial surgery: the rapid progression of the screw extrusion after initial pull-out (6 days) was documented by several radiographs and spontaneous closure of the fistula was achieved. [ABSTRACT FROM AUTHOR]

Study Design: Case report and clinical discussion. Objective: To describe a rare case of intradural cervical disc herniation in a patient with Klippel-Feil syndrome (KFS). Summary Of Background Data: KFS is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. The development of a cervical disc herniation in a nonfused segment is uncommon. Intradural disc herniation is rare, with only 21 cases reported in the cervical region. Methods: We present a case of a 52-year-old woman with KFS (C5-C6 fusion) who developed acute radiculopathy secondary to an intradural cervical disc herniation. Neurologic examination revealed a mild (Grade 3/5) decrease in motor function of the fingers and difficulty in performing fine motor tasks with right hand. Results: The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation and anterior plating; exploration of the surgical field revealed 2 intradural disc fragments. After surgery, she experienced a complete remission of the symptoms. Conclusion: To our knowledge, this is the first case of intradural cervical disc herniation in a KFS patient described in the literature. [ABSTRACT FROM AUTHOR]

Study Design: A case report and clinical discussion., Objective: To describe a rare complication of a cyst of the ligamentum flavum, which bled spontaneously, provoking an acute lower limb monoparesis and lumbar sciatic pain. SUMMARY OF BACKGROUNDS DATA: Cysts of the ligamentum flavum have been rarely reported. Intraspinal degenerative cysts described in literature are usually juxta-articular (synovial and ganglion) cysts and have a similar radiologic appearance. They are preferentially located in the lumbar spine, while the cervical localization is unusual. Hemorrhage into the cyst is an uncommon complication and an extremely rare cause of nerve root compression., Methods: A 59-year-old woman presented with sudden severe radicular lumbar deficit and pain secondary to acute hemorrhage into a ligamentum flavum cyst. Magnetic resonance imaging showed at L3-L4 level a lobulated slightly hyperintense mass with a ventral area of marked hyperintensity in T1 images, hypointense on T2 images. Signal within the lesion was suggestive of intralesional hemorrhage., Results: Complete resection of the lesion was performed, resulting in immediate recovery. The cyst was quite rounded, brownish, and contained rest of both partially fresh and coagulated hematoma. Histologic examination revealed myxoid degeneration of the ligamentum flavum with an hemorrage in the cystic cavity without a synovial layer., Conclusions: This report identifies a rare case of radicular lumbar deficit and pain secondary to acute hemorrhage into a ligamentum flavum cyst. The pathogenesis and clinicopathologic characteristics of this lesion are described.

Study Design: A case report and clinical discussion., Objective: To describe a rare but fatal complication secondary to oxygen-ozone therapy for the treatment of herniated lumbar disc., Summary of Background Data: Previously reported complications secondary to oxygen-ozone therapy are rarely reported. Septic discitis and epidural abscesses have been reported after myelography, lumbar puncture, paravertebral injections, epidural anesthesia, acupuncture, and intradiscal therapy with chymopapain. We report the first case of a local infection with systemic fatal dissemination secondary to this treatment., Methods: A 57-year-old man previously treated with oxygen-ozone therapy presented low back and bilateral pain. The lumbar computed tomography revealed the presence of L4-L5 and L5-S1 herniated discs., Results: Three days after admission in the hospital, the patient developed a fulminant septicemia. An abdominal-pelvic and chest computed tomography and blood culture led to the diagnosis of pyogenic lumbar muscle involvement, accompanied with septic pulmonary embolism secondary to Escherichia coli infection., Conclusions: This case report identifies a rare and fatal complication of oxygen-ozone therapy in the treatment of a herniated lumbar disc. Acute fatal septicemia should be considered among the major complications of the oxygen-ozone therapy in the treatment of a herniated lumbar disc.