gms | German Medical Science

Biocompatible osteoconductive polymer (BOP) graft is used in anterior cervical discectomy for several years. Recently, its implementation has declined in many centers due to complications. BOP graft extrusion can be without symptoms and undetectable, because the graft is radio lucent. We report a case of oral BOP graft extrusion eight years after anterior discectomy.

A 50-year-old man with a 12-months history of weakness and numbness affecting the deltoid muscle on the left side in combination with neck pain. On examination he demonstrated a sensomotor C4 sign on the left side. MR images of the cervical spine revealed a soft herniated disk at the C3/4 level as the main finding. The patient underwent an anterior cervical discectomy and fusion at the C3/4 level. A BOP graft was inserted without any problems. Postoperatively, the patient described improvement in his neurological symptoms.

After eight years he reported on intermittent dysphagia to solids. A cervical spine CT was arranged and a hypodense shadow was noted anterior to the space of C3/4. The oesophagogramm reveled a posterior constriction of the oesophagus at the C3/4 level. Two days later the patient expectorated and spat up a part of the BOP graft. The event was painless and without bleeding. The gastroscopy demonstrates no lesion of the mucosa. One month later, the patient remained well with no symptoms of dysphagia.

Recently BOP graft extrusion were described. Symptoms suggesting extrusion included dysphagia and throat pain. There is one possibility to detect graft extrusion with CT or later with a barium swallow, which can demonstrate a posterior constriction of the oesophagus. This is the first report of oral BOP graft extrusion after such a long time.