J Korean Orthop Assoc.  2007 Jun;42(3):404-409. 10.4055/jkoa.2007.42.3.404.

Esophageal Fistula Formation by MetalLoosening following Anterior Cervical Arthrodesis: A Case Report

• Song KJ
• Kim KH
• Park JH
• Lee JM

• KMID: 2186568
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.404

Abstract

An esophageal injury after an anterior cervical discectomy and fusion with plating is a well known but a fatal complication. If the diagnosis is delayed, inflammation can spread out into the neighboring main organs resulting in a very poor prognosis despite vigorous treatment. We report a case of esophageal fistula formation as a result of infected metal loosening after an anterior cervical discectomy and fusion with plating, which was treated successfully with a satisfactory clinical outcome.

Keyword

Esophageal fistula; Anterior cervical fusion; Metal loosening

MeSH Terms

Arthrodesis*
Diagnosis
Diskectomy
Esophageal Fistula*
Inflammation
Prognosis

Figure

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  Fig. 1 Radiographs immediately after the index operation at a local clinic shows a normal sagittal alignment with cages and plate in the correct position.

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  Fig. 2 Radiographs 8 months after the index operation; back-out of screws, one screw lost after the index surgery with suspicious infectious loosening. The white arrow indicates gas in the pouch at the midportion of the plate.

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  Fig. 3 Follow-up radiograph of plain film at the secondary visit. Radiographs 18 months after the index operation; back-out of screws, another screw lost after the index surgery and progressive infectious loosening. The white arrow indicates gas in the pouch at the lower part of the plate.

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  Fig. 4 Initial esophagogram taken 8 days after revision surgery. An approximately 6 mm sized esophageal fistula in esophagopharyngeal junction and an approximately 7 cm sized barium collection in the left sided paraesophageal region.

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  Fig. 5 Follow-up esophagogram taken 4 weeks after Levintube insertion. The esophageal fistula size had decreased and was approximately 1.8 cm in size lined pouch located at the esophagopharyngeal junction site.

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  Fig. 6 Last follow-up plain radiographs showing solid fusion with a normal sagittal alignment 12 months after revision surgery.

Reference

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