Vertebral prosthetic arthrodesis migration to the esophageal lumen: a rare cause of dysphagia.

of progressive dysphagia. He had a past medical history of recurrent spinal hyda− tidosis at the D1 ± 2 level, which was sur− gically treated in 2000 and 2002 with a total corporectomy of the D1 vertebrae, removal of cysts, arthrodesis with a Moss prosthesis, and insertion of a titanium implant. In 2004, computed tomography (CT) showed the migration of the pros− thesis to the posterior mediastinum. The patient underwent repeat surgery but the prosthetic arthrodesis could be only partially removed. One year later, he com− plained of moderate dysphagia. An upper endoscopy was performed, showing an extrinsic compression at the level of cer− vical esophagus with normal appearing mucosa (l" Figure 1). Because of progres− sion of dysphagia, a second upper endos− copy was performed 6 months later, and revealed a foreign body in the lumen of the esophagus, at the level of the previous extrinsic compression, that was impossi− ble to mobilize (l" Figure 2). The CT image confirmed that the foreign body was the residual arthrodesis, which had progressed through the posterior me− diastinum, and had eroded the esopha− geal wall (l" Figure 3). Using CT, it was also possible to identify a fistulous tract from the D1 ± 2 level to the esophagus, which was the pathway followed by the arthrodesis when migrating to the esoph− ageal lumen. The patient underwent sur− gery, and the residual arthrodesis was re− moved without complications. Hydatid disease is relatively common in the Mediterranean area, but bone hy− datidosis is rare and occurs in 1 ± 2.5 % of cases of human hydatidosis [1,2]. About 50 % of cases of bone hydatidosis are spi− nal [3, 4]. Surgery is the treatment of choice, with removal of the affected ver− tebrae combined with prosthetic bone fixation. To our knowledge, this is the first case reported with migration of the verte− bral prosthetic arthrodesis eroding the esophageal wall and, therefore, repre− sents an unusual case of dysphagia.