Delayed spontaneous expulsion of a stand-alone cervical interbody cage through the oral cavity: a case report and review of the literature.

Abstract

Spontaneous oral extrusion of cervical spine hardware is an exceptionally rare complication following anterior cervical discectomy and fusion (ACDF), with only a few cases documented in the literature, none involving a stand-alone interbody cage. This paper presents what appears to be the first reported case of spontaneous expectoration of a stand-alone cervical cage in a 54-year-old man, two years after undergoing ACDF at the C3-C4 level. The patient experienced progressive dysphagia and foreign-body sensation, culminating in sudden expulsion of the implant during a coughing episode. Imaging revealed a large prevertebral collection with a fistulous tract to the hypopharynx, but without bone erosion, acute infection, or neurological deficits. Conservative management with intravenous antibiotics and close clinical monitoring led to a favorable outcome, avoiding surgical intervention. A systematic review of the literature identified 14 similar cases of oral extrusion of cervical hardware, most involving screws, bone grafts, or constructs, but none describing the expulsion of an unplated interbody cage. This case emphasizes the need for long-term vigilance following ACDF, even in seemingly uncomplicated cases, and suggests that conservative treatment may be an appropriate strategy in select, clinically stable patients.