Korean J Neurotrauma.  2015 Oct;11(2):191-194. 10.13004/kjnt.2015.11.2.191.

Delayed Esophagus Perforation after Anterior Cervical Spine Surgery

• Yang SY
• Lee SB
• Cho KS

• KMID: 2378286
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.191

Abstract

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.

Keyword

Esophageal perforation; Cervical vertebrae; Complications

MeSH Terms

Cervical Vertebrae
Deglutition Disorders
Diskectomy
Emergency Service, Hospital
Esophageal Perforation
Esophagus*
Female
Fever
Humans
Middle Aged
Neck Pain
Pneumonia, Aspiration
Spine*

Figure

• 

  FIGURE 1 Lateral radiograph of the cervical spine showing appropriate placement of the plate from C6 to C7 without hardware failure.

• 

  FIGURE 2 Esophagoscopic image shows the cervical plate protruding through the posterior wall of the esophagus.

• 

  FIGURE 3 Preoperative cervical spine computed tomographic scan shows the prevertebral gas between plate and spinal column.

Reference

1. Adamek HE, Jakobs R, Dorlars D, Martin WR, Krömer MU, Riemann JF. Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy. Scand J Gastroenterol. 1997; 32:411–414. PMID: 9175199.

2. Altorjay A, Kiss J, Vörös A, Szirányi E. The role of esophagectomy in the management of esophageal perforations. Ann Thorac Surg. 1998; 65:1433–1436. PMID: 9594880.

3. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993; 75:1298–1307. PMID: 8408151.

4. Cloward RB. Complications of anterior cervical disc operation and their treatment. Surgery. 1971; 69:175–182. PMID: 4923689.

5. English GM, Hsu SF, Edgar R, Gibson-Eccles M. Oesophageal trauma in patients with spinal cord injury. Paraplegia. 1992; 30:903–912. PMID: 1287544.

6. Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW. Esophageal perforations after anterior cervical surgery. J Spinal Disord. 2000; 13:77–84. PMID: 10710155.

7. Navarro R, Javahery R, Eismont F, Arnold DJ, Bhatia NN, Vanni S, et al. The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery. Spine (Phila Pa 1976). 2005; 30:E617–E622. PMID: 16227880.

8. Newhouse KE, Lindsey RW, Clark CR, Lieponis J, Murphy MJ. Esophageal perforation following anterior cervical spine surgery. Spine (Phila Pa 1976). 1989; 14:1051–1053. PMID: 2588052.

9. Sarr MG, Pemberton JH, Payne WS. Management of instrumental perforations of the esophagus. J Thorac Cardiovasc Surg. 1982; 84:211–218. PMID: 7098508.

10. Sharma RR, Sethu AU, Lad SD, Turel KE, Pawar SJ. Pharyngeal perforation and spontaneous extrusion of the cervical graft with its fixation device: a late complication of C2-C3 fusion via anterior approach. J Clin Neurosci. 2001; 8:464–468. PMID: 11535022.

11. Solerio D, Ruffini E, Gargiulo G, Camandona M, Raggio E, Solini A, et al. Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating. Eur Spine J. 2008; 17(Suppl 2):S280–S284. PMID: 18224356.

12. Welsh LW, Welsh JJ, Chinnici JC. Dysphagia due to cervical spine surgery. Ann Otol Rhinol Laryngol. 1987; 96(1 Pt 1):112–115. PMID: 3813373.

13. Witwer BP, Resnick DK. elayed esophageal injury without instrumentation failure: complication of anterior cervical instrumentation. J Spinal Disord Tech. 2003; 16:519–523. PMID: 14657748.

14. Zdichavsky M, Blauth M, Bosch U, Rosenthal H, Knop C, Bastian L. Late esophageal perforation complicating anterior cervical plate fixation in ankylosing spondylitis: a case report and review of the literature. Arch Orthop Trauma Surg. 2004; 24:349–353. PMID: 15071748.