Retropharyngeal Granulation: Delayed Complication of Anterior Cervical Diskectomy and Fusion in C2–3

Background A 26-year-old man presented with acute quadriparesis owing to a traffic accident. A computed tomography scan revealed a hangman fracture and locking of the left facet joint at C2–3. Magnetic resonance imaging showed a high signal change of the spinal cord on T2-weighted image and hemorrhage in the C2–3 level. Case Description An emergency closed reduction after anterior cervical diskectomy and fusion were performed for spinal stability and decompression of the dural sac. Five months postoperatively, C1–2–3 posterior wiring using an iliac bone graft with the Brook method was performed due to nonunion of C2–3. After using the posterior cervical approach, the patient began complaining about the difficulty in swallowing. A 5 × 2 × 1-cm-sized posterior pharyngeal wall mass was detected on an endoscopic examination. Despite conservative management, the retropharyngeal mass progressed and dysphagia worsened, so the retropharyngeal wall granulation mass was resected by a laryngologist. Despite removal of the granulation mass, dysphagia and throat discomfort persisted for about 2 years. The plate and screws were removed considering their possible correlation with the granulation tissue. One month after plate removal, the retropharyngeal granulation tissue resolved almost spontaneously. At the last follow-up, the radiologic examination showed well-fused C1–2–3 with good alignment. The patient had no residual neurologic deficits or dysphagia. Conclusions Retropharyngeal granulation can occur as a late complication associated with plate fixation after anterior cervical diskectomy and fusion. Recurrent retropharyngeal wall granulation caused by plate irritation might only be resolved after plate and screw removal.