We present a case of delayed oral extrusion of a screw after anterior cervical interbody fusion in a 68-year-old man with osteoporosis. Fifteen months earlier, he had undergone C5 corpectomy and anterior cervical interbody fusion at C4-6 for multiple spinal stenoses. The patient was nearly asymptomatic, except for a foreign body sensation in his throat. We conclude that the use of a mesh graft or other instrument in elderly patients and those with osteoporosis or problematic bone quality should be considered carefully and that if surgery were to be performed, periodic postoperative follow-up evaluations are mandatory.