Multislice Helical CT in the Diagnosis of Pharyngovertebral Fistula Due to Loosening of Anterior Screw-Plate Construct

Abstract

Late dysphagia is a rare condition that results from hardware failure in anterior spine surgery patients. Dysphagia should be evaluated to find out the possible underlying causes. A barium swallow study and multislice helical computed tomography (CT) scan were used to evaluate a patient suffering from dysphagia 8 months after an anterior cervical fusion of C4-C7 vertebrae. A videofluoroscopic swallow study with a low-viscosity, high-density barium solution and different table tilt levels for obtaining slow passage of the barium meal revealed the existence of an esophagovertebral fistula with 2 ostia: one at the contact side of the screw and the other at a lower level with a pouch around the plate. A multislice helical CT scan provided volumetric data and multiplanar reconstruction that enabled us to delineate the extent of the abscess along the plate through the paravertebral space. It also showed the fistula location and relation of the fistula to the displaced screw, as well as the thickened retroesophageal soft tissue. Anterior spinal surgery patients should be followed carefully for progressive dysphagia. Videofluoroscopic swallow studies and multislice helical CT scans are efficient and complementary tools in the evaluation of late dysphagia.