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1
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Kong CG, Park JB. Postoperative Infection After Esophageal Injury in Anterior Cervical Spine Surgery: A Comprehensive Review of Diagnosis, Management, and Outcomes. J Clin Med 2025; 14:3244. [PMID: 40364274 PMCID: PMC12072850 DOI: 10.3390/jcm14093244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 04/26/2025] [Accepted: 05/06/2025] [Indexed: 05/15/2025] Open
Abstract
Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes.
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Affiliation(s)
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea;
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2
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Ivanov I, Mitev D. Surgical management of non-traumatic hypopharyngeal perforation with descending mediastinitis. Folia Med (Plovdiv) 2025; 67. [PMID: 40270137 DOI: 10.3897/folmed.67.e131189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 11/11/2024] [Indexed: 04/25/2025] Open
Abstract
Perforation of the hypopharynx is an extremely rare condition of various etiologies. In even rarer cases, it can lead to mediastinitis, a serious complication with a high mortality rate of up to 35%. We present a case of a 52-year-old male patient with a purulent descending mediastinitis caused by a rare condition of rupture of the hypopharynx after the ingestion of solid food. Mediastinal gas and fluid as well as pleural empyema were observed on CT scan. The case is unique because of the cervical surgical approach used to treat it, as well as a number of techniques that appear to control the infection and treat the source of mediastinitis. The patient recovered completely 20 days postoperatively and was followed up clinically and by computed tomography without persistent symptoms or late complications.
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Affiliation(s)
| | - Dimo Mitev
- Heart and Brain Hospital, Burgas, Bulgaria
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3
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Du J, Gao X, Hao D, Quan Z, Yan L, He B. Retrospective analysis of 10 cases with esophageal fistula after anterior surgery for cervical spine fracture. Heliyon 2023; 9:e21244. [PMID: 37908714 PMCID: PMC10613885 DOI: 10.1016/j.heliyon.2023.e21244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
Objective This study aims to discuss the appropriate treatment of esophageal fistula following anterior surgery for cervical spine fracture. Methods Clinical data of patients with cervical spine fracture treated at our research center from January 2000 to December 2019 were screened. Data of patients with esophageal fistula were included, and the causes of injury, diagnosis, and treatment were retrospectively analyzed. Results A total of 3578 patients with cervical spine fracture were screened, among whom there were 10 cases (0.28 %) of esophageal fistula. 60 % of the cases were early-onset and all were caused by intraoperative electric knife injury. The positive rate of early endoscopy was only 25 %, while routine radiography showed a positive rate of 33.3 % after three attempts. Among the six patients with early-onset esophageal fistula, three underwent sternocleidomastoid flap transfer and two underwent primary suture, all achieving successful healing. In the four cases of late-onset esophageal fistula, two patients received implant removal, debridement, incision lavage, and sternocleidomastoid muscle flap transfer three weeks later. One patient received implant removal, debridement, vacuum sealing drainage, followed by sternocleidomastoid muscle pedicle transfer muscle flap plus lavage two weeks later and achieved complete recovery. All patients gargled alternately with metronidazole and chlorhexidine gargle after surgery. Conclusion The occurrence of esophageal fistula is associated with surgical procedures, esophageal injury, and implant compression. Esophagography and endoscopy are the primary diagnostic methods, while incision exploration after ingestion of food mixed with methylene serves as a supplementary approach. Recommended treatments include alternating metronidazole and chlorhexidine gargles, esophageal rest, repair of the fistula, muscle flap packing, lavage and drainage, nutritional support, and removal of internal fixation if necessary. Post-surgery administration of antibiotics should continue until three consecutive lavage cultures yield negative results.
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Affiliation(s)
- Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, Shaanxi Province, China
| | - Xiangcheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, Shaanxi Province, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, Shaanxi Province, China
| | - Zhengxue Quan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, Shaanxi Province, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, Shaanxi Province, China
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Xia P, Tao P, Zhao X, Peng X, Chen S, Ma X, Fan L, Feng J, Pu F. Anterior debridement combined with autogenous iliac bone graft fusion for the treatment of lower cervical tuberculosis: a multicenter retrospective study. J Orthop Traumatol 2023; 24:48. [PMID: 37709959 PMCID: PMC10501986 DOI: 10.1186/s10195-023-00730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND This study aimed to analyze the clinical efficacy of one-stage anterior debridement of lower cervical tuberculosis using iliac crest bone graft fusion and internal fixation. MATERIALS AND METHODS A retrospective analysis was performed on 48 patients with lower cervical tuberculosis admitted to multiple medical centers from June 2018 to June 2021. Among them, 36 patients had lesions involving two vertebrae and 12 patients had lesions involving more than three vertebrae. All patients were treated with quadruple antituberculosis drugs for more than 2 weeks before the operation, and then treated with one-stage anterior debridement and autogenous iliac bone graft fusion combined with titanium plate internal fixation. After the operation, antituberculosis drugs were continued for 12-18 months. The patients were followed-up to observe the improvement in clinical symptoms, bone graft fusion, Cobb angle, visual analog score (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and neurological function. RESULTS The patients were followed-up for 13-43 months, with an average of 21.46 ± 1.52 months. The clinical symptoms significantly improved after the operation. The bone graft was completely fused in all patients, and the bone fusion time was 3-6 months, with an average of 4.16 ± 0.47 months. At the last follow-up, the Cobb angle, VAS, ESR, and CRP level were significantly lower than those before surgery (P < 0.05). None of the patients had loosening, detachment, or rupture of the internal fixation, and no recurrence occurred. All surgical incisions healed in one stage without infection or sinus formation. The preoperative Frankel neurological function classification was grade B in 7 cases, grade C in 13, grade D in 18, and grade E in 10. At the last follow-up, 8 cases recovered to grade D and 40 recovered to grade E. CONCLUSIONS For patients with lower cervical tuberculosis, based on oral treatment with quadruple antituberculosis drugs, direct decompression through anterior debridement, followed by autologous iliac bone graft fusion combined with internal fixation can completely remove tuberculosis foci, rebuild the stability of the cervical spine, and obtain good clinical efficacy. Level of evidence Level 3.
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Affiliation(s)
- Ping Xia
- Department of Orthopaedics, Wuhan Fourth Hospital (Puai Hospital), Wuhan, China
| | - Pengfei Tao
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolong Zhao
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Peng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Songfeng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Xiucai Ma
- Department of Bone and Soft Tissue Oncology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Lei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Feng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Feifei Pu
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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5
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Fetz A, Ghaseminejad F, Kim HJ, Gan SI. Code Stroke Postendoscopy: A Case of Pneumocephalus From a Spinal-Esophageal Fistula. ACG Case Rep J 2023; 10:e01057. [PMID: 37305800 PMCID: PMC10249714 DOI: 10.14309/crj.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Esophageal fistula to the respiratory tract and mediastinum is a well-described complication from esophageal malignancies. Spinal-esophageal fistula (SEF) on the other hand is a much rarer complication that has only been reported in few instances. Here, we report a unique case of fatal spinal-esophageal fistula with an associated pneumocephalus in an 83-year-old woman with metastatic esophageal squamous cell carcinoma.
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Affiliation(s)
- Andrew Fetz
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Farhad Ghaseminejad
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Jae Kim
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - S. Ian Gan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Out of View: A Large Esophageal Ulcer With Fistula to the Spine. ACG Case Rep J 2023; 10:e00883. [PMID: 36846358 PMCID: PMC9946431 DOI: 10.14309/crj.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/25/2022] [Indexed: 02/23/2023] Open
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Moletta L, Pierobon ES, Salvador R, Volpin F, Finocchiaro FM, Capovilla G, Piangerelli A, Ciccioli E, Zanchettin G, Costantini M, Merigliano S, Valmasoni M. Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature. Global Spine J 2022; 12:719-731. [PMID: 33887971 PMCID: PMC9109565 DOI: 10.1177/21925682211005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Case series and systematic review of the Literature. OBJECTIVES Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. METHODS Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. RESULTS Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. CONCLUSIONS PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.
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Affiliation(s)
- Lucia Moletta
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Renato Salvador
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Francesco Volpin
- Department of Neurosciences,
University Hospital of Padova, Unit of Neurosurgery, Via Giustiniani 2, Padova,
Italy
| | | | - Giovanni Capovilla
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Alfredo Piangerelli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Eleonora Ciccioli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Gianpietro Zanchettin
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
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8
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Kong QJ, Sun XF, Fu ZY, Wang Y, Sun JC, Sun PD, Xu XM, Guo YF, Ou-Yang J, Zhong SZ, Shi JG. Anatomical Evaluation of Spinal Nerve and Cervical Intervertebral Foramina in Anterior Controllable Antedisplacement and Fusion Surgery: A Cadaveric and Radiologic Study. Orthop Surg 2021; 14:331-340. [PMID: 34935286 PMCID: PMC8867434 DOI: 10.1111/os.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To achieve the anatomical evaluation of spinal nerve and cervical intervertebral foramina in anterior controllable antedisplacement and fusion (ACAF) surgery, a novel surgical technique with the wider decompression, through a cadaveric and radiologic study. Methods Radiographic data of consecutive 47 patients (21 by ACAF and 26 by anterior cervical corpectomy and fusion [ACCF]) who have accepted surgery for treatment of cervical ossification of the posterior longitudinal ligament(OPLL) and stenosis from March 2017 to March 2018 were retrospectively reviewed and compared between an ACAF group and ACCF group. Three postoperative radiographic parameters were evaluated: the decompression width and the satisfaction rate of decompression at the entrance zone of intervertebral foramina on computed tomography (CT), and the transverse diameter of spinal cord in the decompression levels on magnetic resonance imaging (MRI). In the anatomic study, three fresh cadaveric spines (death within 3 months) undergoing ACAF surgery were also studied. Four anatomic parameters were evaluated: the width of groove, the distance between the bilateral origins of ventral rootlets, the length of ventral rootlet from their origin to the intervertebral foramina, the descending angle of ventral rootlet. Results The groove created in ACAF surgery included the bilateral origins of ventral rootlets. The rootlets tended to be vertical from the rostral to the caudal direction as their takeoff points from the central thecal sac became higher and farther away from their corresponding intervertebral foramina gradually. No differences were identified between left and right in terms of the length of ventral rootlet from the origin to the intervertebral foramina and the descending angle of ventral rootlet. The decompression width was significantly greater in ACAF group (19.2 ± 1.2 vs 14.7 ± 1.2, 21.3 ± 2.2 vs 15.4 ± 0.9, 21.5 ± 2.1 vs 15.7 ± 1.0, 21.9 ± 1.6 vs 15.9 ± 0.8, from C3 to C6). The satisfactory rate of decompression at the entrance zone of intervertebral foramina tended to be better in the left side in ACAF group (significant differences were identified in the left side at C3/4, C4/5, C6/7 level, and in the right side at C4/5 level when compared with ACCF). And decompression width was significantly greater than the transverse diameter of spinal cord in ACAF group. Comparatively, there existed no significant difference in the ACCF group besides the C5 level. Conclusion ACAF can decompress the entrance zone of intervertebral foramina effectively and its decompression width includes the origins and massive running part of bilateral ventral rootlets. Due to its wider decompression range, ACAF can be used as a revision strategy for the patients with failed ACCF.
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Affiliation(s)
- Qing-Jie Kong
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Fei Sun
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Yi Fu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Wang
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing-Chuan Sun
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Xi-Ming Xu
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yong-Fei Guo
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Ou-Yang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Shi-Zhen Zhong
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Jian-Gang Shi
- Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Algorithmic Approach to Reconstruction of Esophageal/Hypopharyngeal Injuries After Anterior Cervical Spinal Fusion. World Neurosurg 2021; 155:e655-e664. [PMID: 34478891 DOI: 10.1016/j.wneu.2021.08.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anterior cervical disk fusion (ACDF) is a common surgical approach for the treatment of cervical spine pathology. Esophageal perforations, though uncommon, are a devastating complication of this surgery. The objective of this paper is to assess the success of different treatment approaches for the management of esophageal/pharyngeal injury after ACDF. METHODS Given the absence of prospective trials, the review includes institutional case reports and case series from 1985-2020 in the English language literature. Only cases of esophageal/pharyngeal injury in the setting of anterior cervical hardware were considered for study inclusion. For purposes of this study, treatment success is defined as resumption of oral intake. RESULTS The database review identified 76 distinct series that meet criteria for study inclusion, with 173 patients available for analysis. A heterogeneous array of treatments was used for the management of pharyngoesophageal injuries after ACDF ranging from observation to complex free tissue reconstruction, with varying degrees of treatment success reported. We identified a number of factors, specifically duration of injury from initial ACDF procedure, which may impact the complexity of treatment required to maximize likelihood of treatment success. CONCLUSIONS Pharyngoesophageal injuries, albeit rare, are a serious and often complex complication after ACDF procedures. We propose a detailed algorithmic approach to guide decision making if faced with this clinical challenge. The huge variability in how these patients are treated emphasizes the potential utility of future multiinstitutional studies.
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Dahm J, Nwaudo D, Gooi Z, Lee M, El Dafrawy M. Migration of an Anterior Cervical Discectomy and Fusion Screw into the Constrictor Muscle of the Hypopharynx: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00078. [PMID: 34010178 DOI: 10.2106/jbjs.cc.20.00873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 53-year-old man developed dysphagia 4 years after anterior cervical discectomy and fusion (ACDF), and radiographs revealed a dislodged screw anterior to the ACDF plate. Intraoperatively, the screw was found to be completely embedded within the pharyngeal constrictor muscle fibers and was removed with assistance from otolaryngology without injury to the pharyngeal mucosa. CONCLUSION Implant migration after ACDF can variably damage tracheoesophageal and retropharyngeal structures, and a multidisciplinary approach involving otolaryngology or thoracic surgery may be required to diagnose and treat these complications.
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Affiliation(s)
- James Dahm
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Darlington Nwaudo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Zhen Gooi
- Department of Otolaryngology, University of Chicago Medical Center, Chicago, Illinois
| | - Michael Lee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Mostafa El Dafrawy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
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11
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Lee JH, Kim E, Choi YH. Encephalitis as a complication of a spinal-esophageal fistula due to discitis. Clin Case Rep 2019; 7:2190-2193. [PMID: 31788277 PMCID: PMC6878085 DOI: 10.1002/ccr3.2471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022] Open
Abstract
In patients with back or scapular pain, if there is evidence of neurological symptoms, fever, chills, malaise, or other signs of infection, the work-up should consider the possibility of a spinal-esophageal fistula.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
| | - Eun Kim
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
| | - Yoon Hee Choi
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
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12
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Rama-López J, Tomás-Fernandez M, García-Garza C, Martínez-Madrigal M. Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery. Head Neck 2017; 40:E13-E16. [PMID: 29206327 DOI: 10.1002/hed.25030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/01/2017] [Accepted: 10/25/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections. METHODS We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery. RESULTS The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization. CONCLUSION We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.
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Affiliation(s)
- Julio Rama-López
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
| | | | - César García-Garza
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
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Elgafy H, Khan M, Azurdia J, Peters N. Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy: A case report and review of the literature. World J Orthop 2017; 8:651-655. [PMID: 28875132 PMCID: PMC5565498 DOI: 10.5312/wjo.v8.i8.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023] Open
Abstract
A 67-year-old female patient developed an esophagocutaneous fistula 4 mo after C4 and C5 partial corpectomy. Plain radiograph and computed tomography (CT) scan of cervical spine showed inferior screws pullout with plate migration that caused the esophageal perforation. Management included removal of anterior hardware, revision C4-5 corpectomy, iliac crest strut autograft and halo orthosis immobilization. The fistula was treated using antibiotics and a 10-french gauge rubber tube for daily irrigation and Penrose drain. At 3 mo, the esophagocutaneous fistula healed and the patient resumed oral feeding. Six months follow-up CT scan showed sound fusion with graft incorporation. At two-year follow-up, patient denied any neck pain or dysphagia. This case report presents a successful outcome of a conservative open wound management without attempted repair. The importance of this case report is to highlight this treatment method that may be considered in such a rare complication particularly if surgical repair failed.
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Halani SH, Baum GR, Riley JP, Pradilla G, Refai D, Rodts GE, Ahmad FU. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine 2016; 25:285-91. [PMID: 27081708 DOI: 10.3171/2016.1.spine15898] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included pneumonia (n = 6), mediastinitis (n = 4), osteomyelitis (n = 3), sepsis (n = 3), acute respiratory distress syndrome (n = 2), and recurrent laryngeal nerve damage (n = 1). The mortality rate of esophageal perforation in the analysis was 3.92% (6 of 153 reported patients). CONCLUSIONS Esophageal perforation after anterior cervical spine surgery is a rare complication. This systematic review demonstrates that these perforations can be stratified into 3 categories based on the timing of symptomatic onset: intraoperative, early postoperative (within 30 days of anterior spinal surgery), and delayed. The most common source of esophageal injury is hardware erosion or migration, each of which may vary in their time to symptomatic manifestation.
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Affiliation(s)
- Sameer H Halani
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Griffin R Baum
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan P Riley
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gustavo Pradilla
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel Refai
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gerald E Rodts
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Faiz U Ahmad
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
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Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2037-49. [PMID: 26842882 DOI: 10.1007/s00586-016-4394-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To review relevant data for the management of esophageal perforation after anterior cervical surgery. METHODS A case of delayed esophageal perforation after anterior cervical surgery has been presented and the relevant literature between 1958 and 2014 was reviewed. A total of 57 papers regarding esophageal perforation following anterior cervical surgery were found and utilized in this review. RESULTS The treatment options for esophageal perforation after anterior cervical surgery were discussed and a novel management algorithm was proposed. CONCLUSION Following anterior cervical surgery, patients should be closely followed up in the postoperative period for risk of esophageal perforation. Development of symptoms like dysphagia, pneumonia, fever, odynophagia, hoarseness, weight loss, and breathing difficulty in patients with a history of previous anterior cervical surgery should alert us for a possible esophageal injury. Review of the literature revealed that conservative treatment is advocated for early and small esophageal perforations. Surgical treatment may be considered for large esophageal defects.
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Abstract
Osteoarticular tuberculosis was frequent throughout the world a decade ago but antituberculous chemotherapy and prophylactic measures have clearly contributed to the reduction of its frequency. However, Pott's disease is frequently complicated by an abscess and some locations are exceptional on account of their gravity. We report a case of dorsal spondylodiscitis with a voluminous Pott's abscess compressing the mediastinal structures with a risk of perforating into the trachea.
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Affiliation(s)
- C Dahou Makhloufi
- Service de rhumatologie, CHU de Bab El Oued, université d'Alger, boulevard Saïd Touati, Alger, Algérie.
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Wang D, Dong J, Lu M, Yang BH, Li HP, He XJ. Diagnosis of pharyngeal fistula by video laryngoscopy and its nonsurgical treatment: a case report. Orthop Surg 2014; 6:158-61. [PMID: 24890299 DOI: 10.1111/os.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/21/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dong Wang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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A rare case of hypopharyngeal screw migration after spine stabilization with plating. Case Rep Otolaryngol 2013; 2013:475285. [PMID: 23841003 PMCID: PMC3690641 DOI: 10.1155/2013/475285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Anterior cervical spine fusion and stabilization with plating are well-established surgical procedures for the treatment of myelopathy, cervical spine traumas, and spinal infectious diseases. Various complications have been described in the literature, more frequently, intraoperative bleeding, peri- or postoperative hypopharyngeal, and/or esophageal ruptures with mediastinal deep infection and loosening and extrusion of the screws from the plating. Screw migration has also been observed as a complication of the procedure, either early in the postoperative period or delayed, even after many years. In some instances, the esophageal perforation can recover spontaneously with absence of complications, even if a case of plate failure and graft migration with lethal sudden airways obstruction has been reported. We describe a case of hypopharyngeal screw migration after cervical spine stabilization with plating never described before in the literature.
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