I had my last ACDF Jan 09. I complained of difficulty swallowing and hoarseness. Post op x-Ray shoulder screw back out. My dr felt they were not related. And also was told that the screw was stable. After going to an ENT twice and finally convincing h something needed to be done I had a strobe scope and a barium swallow done today by a speech path and the ENT . They were beyond surprise in what they found. My esophagus is not functioning the way it should due to severe scarring and that stable screw is actually perforatingy esophagus. Also I had major damage to vocal cords. Suggested all hardware out then we'll deal with the vocal cords. So if you know something is not right don't give up. Someone will eventually help you.