1
|
Ivanauskas E, Jones KA. Not Your Typical Sore Throat-A Case Report on Delayed Complications From Cervical Spinal Surgery. Ann Emerg Med 2024; 83:68-71. [PMID: 37676180 DOI: 10.1016/j.annemergmed.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
Esophageal perforation is an uncommon illness with a mortality rate as high as 50%. It is most frequently caused by iatrogenic instrumentation for both diagnostic and therapeutic purposes. Noniatrogenic spontaneous ruptures account for 15% of cases, followed by traumatic injury and rupture secondary to a foreign body.1 Sore throat is a common emergency medicine complaint with an array of causes and severity of pathology. We report a case of a sore throat resulting from esophageal perforation and prevertebral abscess as delayed complications from an anterior cervical surgery.
Collapse
Affiliation(s)
- Emma Ivanauskas
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Kerin A Jones
- Department of Emergency Medicine, Wayne State University, Detroit, MI.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:302-322. [PMID: 32309668 DOI: 10.21037/jss.2020.01.14] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
Collapse
Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Vergnon JM, Huppert J. Removal of a mediastinal osteosynthesis screw by rigid bronchoscopy. Respir Med Res 2019; 75:29-31. [PMID: 31262425 DOI: 10.1016/j.resmer.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- J-M Vergnon
- Department of chest diseases and thoracic oncology, university hospital of Saint-Étienne, 42055, Saint-Étienne, France; UMR Inserm 1059 "Sainbiose" université de Lyon, université Jean-Monnet Saint-Étienne, UFR de médecine campus santé innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France; Société de pneumologie de langue Française, 66 boulevard St-Michel, 75006 Paris, France.
| | - J Huppert
- Neuro-surgical unit, clinique du Parc, 42270 Saint-Priest-en-Jarez, France; Société Française de chirurgie rachidienne, 35760 Saint-Grégoire, France
| |
Collapse
|
5
|
Ouyang P, Lu T, He X, Gao Z, Cai X, Jin Z. Biomechanical Comparison of Integrated Fixation Cage Versus Anterior Cervical Plate and Cage in Anterior Cervical Corpectomy and Fusion (ACCF): A Finite Element Analysis. Med Sci Monit 2019; 25:1489-1498. [PMID: 30799836 PMCID: PMC6400022 DOI: 10.12659/msm.913630] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Anterior cervical plate and cage fixation system (ACPC) used in anterior cervical corpectomy and fusion (ACCF) is reported to incur excess complications. This study aimed to introduce integrated fixation cage (IFC) into ACCF to eliminate the anterior cervical plate (ACP)-related complications. Material/Methods One validated intact and 3 ACCF-simulated C3–C7 cervical spine models were developed. In ACCF models, C5 was corpectomied and fixed by IFC or ACPC. For each model, 1.0 Nm moments of flexion, extension, lateral bending, and torsion were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on screw-vertebra interface, bone graft, and cage-endplate were recorded and analyzed. Results ROMs of C3–C7 were not different in any motion condition between IFC and ACPC models. The maximal von Mises stress on screw-vertebra interface of the IFC model was lower than that of the ACPC models in flexion, extension, and lateral bending, but higher in rotation. The maximal von Mises stress on bone graft of the IFC model was higher compared with the ACPC models, except in flexion. The IFC model showed a higher maximal von Mises stress on cage-endplate interface in all motion planes. Conclusions Based on finite element analysis, IFC provided identical C3–C7 construct stability as ACPC. Compared with ACPC, IFC showed better biomechanical performance on screw-vertebra interface and bone graft, but worse biomechanical performance on cage-endplate interface.
Collapse
Affiliation(s)
- Pengrong Ouyang
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Teng Lu
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xijing He
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Zhongyang Gao
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xuan Cai
- Department of Orthopedic Surgery, The 2nd Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
Schroeder J, Salzmann SN, Hughes AP, Beckman JD, Shue J, Girardi FP. Emergent reintubation following elective cervical surgery: A case series. World J Orthop 2017; 8:465-470. [PMID: 28660138 PMCID: PMC5478489 DOI: 10.5312/wjo.v8.i6.465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/06/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To review cases of emergent reintubation after cervical surgery.
METHODS Patients who were emergently intubated in the post-operative period following cervical surgery were identified. The patients’ prospectively documented demographic parameters, medical history and clinical symptoms were ascertained. Pre-operative radiographs were examined for the extent of their pathology. The details of the operative procedure were discerned.
RESULTS Eight hundred and eighty patients received anterior- or combined anterior-posterior cervical surgery from 2008-2013. Nine patients (1.02%) required emergent reintubation. The interval between extubation to reintubation was 6.2 h [1-12]. Patients were kept intubated after reintubation for 2.3 d [2-3]. Seven patients displayed moderate postoperative edema. One patient was diagnosed with a compressive hematoma which was subsequently evacuated in the OR. Another patient was diagnosed with a pulmonary effusion and treated with diuretics. One patient received a late debridement for an infected hematoma. Six patients reported residual symptoms and three patients made a complete recovery.
CONCLUSION Respiratory compromise is a rare but potentially life threatening complication following cervical surgery. Patients at increased risk should be monitored closely for extended periods of time post-operatively. If the airway is restored adequately in a timely manner through emergent re-intubation, the outcome of the patients is generally favorable.
Collapse
|
8
|
Bhise SD, Mathesul AA, Deokate P, Chandanwale AS, Bartakke GD. Late prevertebral abscess with sinus following anterior cervical corpectomy and fusion. Asian J Neurosurg 2015; 10:272-6. [PMID: 26396628 PMCID: PMC4553753 DOI: 10.4103/1793-5482.161172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Anterior cervical discectomy/corpectomy and fusion is performed in degenerative, traumatic and neoplastic etiologies of the cervical spine. This procedure is highly successful and associated with fewer complications. The rates of early and late postoperative infection have been reported to be between 0.1% and 1.6%, the late infections are being very rare. We report a rare case of a 30-year-old HIV negative, non-diabetic male who developed a late prevertebral cervical abscess with discharging sinus over posterior triangle of neck 3 years after an anterior cervical C6 corpectomy with fibular grafting and buttress screw fixation performed elsewhere for traumatic fracture C6 vertebra. The abscess was drained using radical neck dissection approach with complete excision of sinus track and removal of the infected implant. On culture, the organism was found to be beta-hemolytic streptococci, for which appropriate antibiotics were administered postoperatively. The sinus tract completely healed in 3 months time. Late infection as a complication of anterior cervical spine surgeries is rare and is associated with esophageal perforation, implant migration, seeding of the deep prevertebral space with oropharyngeal flora, or from surgical site/bacteremia or with Zenker's diverticulum. Few cases have been reported till date, but none have presented with a sinus tract. We present a case of delayed prevertebral abscess after cervical spine instrumentation that followed abnormal path causing sinus track to be developed in the site (the posterior triangle of the neck) other than previous incision site. Exploring both triangles of the neck using radical neck dissection approach was essential for complete excision of sinus track, removal of screw and debridement.
Collapse
Affiliation(s)
- Swapnil D Bhise
- Department of Orthopaedics, B J Govt Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Ambarish A Mathesul
- Department of Orthopaedics, B J Govt Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Pravin Deokate
- Department of Orthopaedics, B J Govt Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Ajay S Chandanwale
- Department of Orthopaedics, B J Govt Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Girish D Bartakke
- Department of Orthopaedics, B J Govt Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| |
Collapse
|
9
|
Zapałowicz K, Radek M, Wojdyn M, Pietkiewicz P, Olszewski J. Delayed perforation of posterior pharyngeal wall caused by dislodged bioresorbable interbody cage. Case report. Neurol Neurochir Pol 2014; 48:154-7. [PMID: 24821644 DOI: 10.1016/j.pjnns.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
A 48-year-old man was admitted for the management of congenital anomalies: Arnold-Chiari type I malformation combined with odontoid upward migration. He also had degenerative stenosis of the spinal canal by spurs at C2/C3 and C3/C4 levels. Osseous deformities caused ischaemic changes of the brainstem as well as spinal cord compression. Authors used the Biocage - interbody cage covered by bioresorbable layer to fill the surgically created gap after removal of the right part of C3 vertebral body. Twenty-seven months after implantation, the implant was extruded through posterior pharyngeal wall. Authors describe this unusual case and discuss possible causes of Biocage extrusion.
Collapse
Affiliation(s)
- Krzysztof Zapałowicz
- Department of Neurosurgery and Peripheral Nerve Surgery, Medical University of Łódź, University Hospital WAM-CSW, Łódź, Poland.
| | - Maciej Radek
- Department of Neurosurgery and Peripheral Nerve Surgery, Medical University of Łódź, University Hospital WAM-CSW, Łódź, Poland
| | - Maciej Wojdyn
- Department of Neurosurgery and Peripheral Nerve Surgery, Medical University of Łódź, University Hospital WAM-CSW, Łódź, Poland
| | - Piotr Pietkiewicz
- Department of Otolaryngology and Laryngological Oncology, Medical University of Łódź, University Hospital WAM-CSW, Łódź, Poland
| | - Jurek Olszewski
- Department of Otolaryngology and Laryngological Oncology, Medical University of Łódź, University Hospital WAM-CSW, Łódź, Poland
| |
Collapse
|
10
|
Kim SJ, Ju CI, Kim DM, Kim SW. Delayed esophageal perforation after cervical spine plating. KOREAN JOURNAL OF SPINE 2013; 10:174-6. [PMID: 24757482 PMCID: PMC3941754 DOI: 10.14245/kjs.2013.10.3.174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 01/05/2023]
Abstract
Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to painful neck swelling and dysphagia. Radiological studies revealed a protruding screw and esophageal perforation. The perforation was found during surgery and was successfully repaired. This case emphasizes the need for careful long-term follow-up to check for delayed esophageal perforation in patients that have undergone anterior cervical spine plating.
Collapse
Affiliation(s)
- Seong Jung Kim
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
| | - Dong Min Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
| |
Collapse
|
11
|
Kapu R, Singh M, Pande A, Vasudevan MC, Ramamurthi R. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2013; 3:19-22. [PMID: 23741125 PMCID: PMC3669469 DOI: 10.4103/0974-8237.110121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.
Collapse
Affiliation(s)
- Ravindranath Kapu
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
12
|
Missing screw as a rare complication of anterior cervical instrumentation. Case Rep Orthop 2013; 2013:593905. [PMID: 23634313 PMCID: PMC3619545 DOI: 10.1155/2013/593905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022] Open
Abstract
Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.
Collapse
|
13
|
Hernández Hernández JR, Navarro Barlés G, López-Tomassetti Fernández EM, Vega Benítez V, Núñez Jorge V. Fistula to the native esophagus after pharyngogastrostomy for malignant disease: A rare phenomenon in esophageal surgery. Thorac Cancer 2013; 4:71-74. [PMID: 28920320 DOI: 10.1111/j.1759-7714.2012.00112.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article features the case study of a 32-year-old female patient who had undergone surgery to remove a cervical spine tumor and who later developed cervical esophagus necrosis secondary to the erosion caused by an osteosynthesis 13 years after her prosthetic cervical surgery. Barium swallow did not show anything abnormal, but after an emergency spiral computerized axial tomography (CAT) scan, a paravertebral abscess was found, along with displacement of the fixation plate and the disappearance of the esophageal silhouette on coronal sections. The patient underwent surgery to drain the abscess, extract the osteosynthesis materials and the stabilization plates, and to perform a temporary esophageal exclusion. Two months after this surgery the esophagus was reconstructed by performing a retrosternal pharyngogastrostomy without resection of the remaining cervicothoracic esophagus due to severe fibrosis and the absence of local recurrence. During the immediate post operatory period the patient developed a cervical fistula and after a month of conservative treatment, severe dysphagia was observed. Imaging tests showed a spontaneous fistula from the pharynx to the native esophagus, which prompted extraordinary treatment. Therefore, a jejunal loop was taken to the esophagus in the hiatus with a Roux-en-Y anastomosis to resolve this condition.
Collapse
Affiliation(s)
- Juan Ramón Hernández Hernández
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Gonzalo Navarro Barlés
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | | | - Victor Vega Benítez
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Valentín Núñez Jorge
- Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| |
Collapse
|
14
|
Abstract
Cervical radiculopathy, when resistant to conservative treatment, can require surgical treatment. There are numerous surgical treatment options available, such as posterior cervical foraminotomy, anterior cervical foraminotomy, anterior cervical diskectomy and fusion, and cervical disk arthroplasty. This article describes the surgical techniques, reviews their respective indications, and examines their outcomes.
Collapse
|
15
|
|
16
|
Lower Incidence of Dysphagia With Cervical Arthroplasty Compared With ACDF in a Prospective Randomized Clinical Trial. ACTA ACUST UNITED AC 2010; 23:1-8. [DOI: 10.1097/bsd.0b013e31819e2ab8] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
|
18
|
Mendoza-Lattes S, Clifford K, Bartelt R, Stewart J, Clark CR, Boezaart AP. Dysphagia following anterior cervical arthrodesis is associated with continuous, strong retraction of the esophagus. J Bone Joint Surg Am 2008; 90:256-63. [PMID: 18245583 DOI: 10.2106/jbjs.g.00258] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of dysphagia after anterior cervical decompression and arthrodesis is estimated to be 50% within one month and 21% at twelve months. However, its exact etiology is not well understood. The objective of the present study was to explore the relationship between intraoperative intra-esophageal pressure due to surgical retraction, esophageal mucosal blood flow at the level of surgery, and postoperative dysphagia. Our hypothesis was that sustained elevated pressure on the esophagus during anterior cervical arthrodesis is associated with postoperative dysphagia. METHODS Seventeen selected patients scheduled for anterior cervical arthrodesis were studied. Throughout the procedure, intraluminal pressure in the upper esophageal sphincter was measured (mm Hg) with a custom-made manometer probe and mucosal perfusion was measured at the level of surgery with a laser Doppler flowmeter. The type of retraction chosen by the surgeon was noted. Postoperatively, the patients were specifically evaluated for dysphagia on the first postoperative day and at six weeks, three months, and six months postoperatively with use of the M.D. Anderson Dysphagia Inventory. RESULTS Four of the eleven patients who had dynamic retraction and five of the six patients who had static retraction during surgery had postoperative dysphagia. In the group of patients with dysphagia, the average M.D. Anderson Dysphagia Inventory score decreased from 93.8 +/- 12.1 preoperatively to 67.7 +/- 11.4 on the first postoperative day (p < 0.001). The patients with dysphagia had a significantly higher average intraluminal pressure (60.8 +/- 54.3 compared with 54.4 +/- 51.8 mm Hg; p < 0.0001) as well as significantly lower average mucosal perfusion (26.1 +/- 18.1 compared with 40.8 +/- 26.2 tissue perfusion units; p < 0.0001) in comparison with the asymptomatic patients. CONCLUSIONS Patients with dysphagia following anterior cervical arthrodesis were exposed to higher intraoperative esophageal pressure and decreased esophageal mucosal blood flow during surgical retraction as compared with patients without dysphagia. In this small series, dynamic retraction seemed to be associated with a lower prevalence of postoperative dysphagia.
Collapse
Affiliation(s)
- Sergio Mendoza-Lattes
- Department of Orthopaedic Surgery and Rehabilitation, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Sahjpaul RL. Esophageal perforation from anterior cervical screw migration. ACTA ACUST UNITED AC 2007; 68:205-9; discussion 209-10. [PMID: 17662361 DOI: 10.1016/j.surneu.2006.09.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 09/26/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Esophageal perforation from anterior cervical instrumentation migration is an uncommon but potentially highly morbid or even fatal complication. Early recognition and aggressive investigation and treatment are essential to ensure good outcome. CASE DESCRIPTION A 58-year-old man underwent C6 vertebrectomy and C5-7 interbody fusion with a cage and anterior cervical plate. After surgery he developed fever and recurrence of his symptoms and deficits, but was managed expectantly. He was then referred to the author's institution. A barium swallow demonstrated an esophageal fistula (a Gastrograffin swallow was falsely negative) caused by a migrated screw; serial radiographs confirmed its passage through the gastrointestinal tract. Revision surgery was required to repair the perforation and reconstruct the cervicothoracic spine. Intraoperative esophageal injection of methylene blue was helpful in demonstrating the site of leakage. Despite a prolonged postoperative course complicated by pulmonary embolus, the patient recovered with minimal residual deficit, and continues to do well 2 years later. CONCLUSIONS A high index of suspicion followed by aggressive investigation are crucial in the setting of unexpected neck pain, new neurologic deficit, fever, or swallowing difficulties in the early postoperative period after anterior cervical spine instrumentation. If esophageal perforation is suspected, a barium swallow is recommended over Gastrograffin, which, although less irritating to the surrounding tissues, may be falsely negative. Intraoperative methylene blue injection into the esophageal lumen is useful in identifying the site of perforation.
Collapse
Affiliation(s)
- Ramesh L Sahjpaul
- Division of Neurosurgery, University of British Columbia, North Vancouver, British Columbia, Canada V7L 2L3.
| |
Collapse
|
20
|
Pimenta L, McAfee PC, Cappuccino A, Cunningham BW, Diaz R, Coutinho E. Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine (Phila Pa 1976) 2007; 32:1337-44. [PMID: 17515823 DOI: 10.1097/brs.0b013e318059af12] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN/SETTING Class 2 level of evidence: This is a prospective, consecutive series of 229 prosthetic implantations that were concurrently enrolled between single-level versus multilevel cervical arthroplasty comprising an FDA Pilot Study. OBJECTIVE This study investigated multilevel cervical disc replacement in relation to single-level cervical arthroplasty to find if the same reduction in clinical success would occur with this alternative treatment. SUMMARY OF BACKGROUND DATA Usually, the clinical outcomes of instrumented cervical fusions deteriorate as the number of vertebral levels of involvement increases. METHODS A total of 229 patients presented with cervical herniated nucleus pulposus, cervical spondylosis, and/or adjacent segment disease with cervical radiculopathy or myelopathy. Following anterior cervical neurologic decompression seventy-one patients required porous coated motion (PCM) cervical arthroplasties from C3-C4 to C7-T1 (Group S, single level). Sixty-nine patients underwent 158 multilevel PCM cervical arthroplasties (Group M, multilevel) during the same time interval, for the same indications, performed by the same surgeons under the same clinical protocol: double level, 53 cases; three levels, 12 cases: and 4 levels, 4 cases. RESULTS The self-assessment outcomes instruments showed significantly more improvement for the multilevel cases. The mean improvement in the NDI for the single cases was 37.6% versus the multilevel cases mean improvement in NDI was 52.6% (P = 0.021). The difference between the two was statistically significant. The mean improvement in the VAS showed the same association: single-level mean improvement 58.4% versus the multilevel cases mean VAS improvement was 65.9%. The Odom's were also more improved for the multilevel versus the single-level group: 93.9% versus 90.5% in the excellent, good, and fair categories. The reoperation rates and serious adverse events were similar between the single-level (S = 3) to the multilevel arthroplasty (M = 2) groups. Kaplan-Meier implant survivorship analysis at 3 years for the cohort of 229 prostheses was 94.5% (confidence interval, 1.00-0.820). CONCLUSIONS This prospective study of cervical arthroplasty is the first report to date showing significantly improved clinical outcomes for multilevel cervical arthroplasty compared with single-level cervical disc replacement using an FDA validated outcome instrument.
Collapse
Affiliation(s)
- Luiz Pimenta
- St. Joseph Hospital Scoliosis and Spine Center, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Martínez-Lage JF, Felipe-Murcia M, Martínez-Lage Azorín L. Late prevertebral abscess following anterior cervical plating: The missing screw. Neurocirugia (Astur) 2007; 18:111-4. [PMID: 17497056 DOI: 10.1016/s1130-1473(07)70295-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 51-year-old man underwent a C5-C7 anterior decompression and fusion. Six years later the patient complained of dysphagia caused by displacement of the cervical plate. One week after the scheduled removal of the implanted material, the patient developed a painful cervical swelling and fever. His cervical radiographs showed that a screw was missing compared to previous studies. Computerized tomography showed a large prevertebral abscess anterior to C4-C7. He underwent emergency surgical drainage of the abscess that was followed by total recovery. This report is aimed at describing this unusual complication of cervical instrumentation and to briefly review its pathogenesis and management options.
Collapse
|
22
|
|