Unveiling the Hidden Cause: A Case of Persistent Dysphagia

Esophageal impingement due to hardware failure is a rare complication of cervical spine fusion surgery; dysphagia, on the other hand, is a much more common complication. Here, we present the case of a 72-year-old man with a rare complication of anterior cervical discectomy and fusion (ACDF) induced by a migrated screw, causing dysphagia. The patient, with a history of metastatic renal cell carcinoma, had been undergoing treatment with cabozantinib and nivolumab for a year when he developed new-onset dysphagia over several months. Subsequent investigations, including contrast-enhanced cervical spine CT and esophagogastroduodenoscopy, revealed a prior C5-C7 anterior spinal fusion, with a C7 vertebral body screw protruding into the esophagus. The patient had been in an automobile accident in 2020 but reported no complications until the onset of dysphagia nearly two years later. A modified barium swallow test/fluoroscopic esophagogram confirmed that the protruding screw was responsible for the dysphagia. Afterward, he underwent successful endoscopic surgery to remove the screw, with complete resolution of his dysphagia and no postoperative complications. This case underscores the importance of prompt identification and intervention in managing screw migration into the esophagus, with multidisciplinary collaboration playing a crucial role in achieving successful outcomes.