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Park J, Lee DG. Diagnostic and Management Challenges of Esophageal Rupture with Concomitant Cervical Abscess in Chronic High Cervical Tetraplegia. Diagnostics (Basel) 2024; 14:391. [PMID: 38396429 PMCID: PMC10887811 DOI: 10.3390/diagnostics14040391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
A 65-year-old with a history of spinal cord injury and previous cervical surgery presented with persistent fever despite antibiotic treatment. MRI scans revealed an abscess in the neck extending from C3 to C6, with associated osteomyelitis. After an initial discharge following antibiotic therapy, the patient was readmitted due to recurrent systemic infection symptoms and another abscess. A subsequent endoscopy showed esophageal rupture with protruding cervical fusion metal. Due to operative risks, a percutaneous endoscopic gastrostomy was performed without further infection recurrence. The absence of typical imaging signs of esophageal rupture made diagnosis difficult. The infection spread through the cervical fascia from superficial to deep cervical areas. Esophageal rupture, a rare complication of cervical surgery, presents with varying symptoms depending on its location and was particularly challenging to diagnose in this patient due to high cervical tetraplegia, which masked typical pain responses. Therefore, this case highlights the need to consider esophageal rupture in differential diagnoses for chronic ACDF patients, even when typical symptoms are absent.
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Affiliation(s)
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea;
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2
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Frankel L, Ardeljan AD, Santizo G, Guerra M, Gharat G, Alnajar S, Manjani D, Ardeljan A, Takabe K, Rashid OM. Esophageal Perforation in a 76-Year-Old Man After C5-C7 Anterior Discectomy and Anterior Plate Fusion. World J Oncol 2023; 14:158-163. [PMID: 37188039 PMCID: PMC10181427 DOI: 10.14740/wjon1563] [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: 12/29/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is indicated for the treatment of various cervical pathologies, including myelopathy, cervical disc degeneration, and radiculopathy. Esophageal perforation is a rare postsurgical complication of ACDF, although it poses serious and potentially fatal outcomes. Esophageal perforation has been described as the most fatal complication of the gastrointestinal tract as delayed diagnosis can lead to sepsis and death. Diagnosis of this complication is often difficult because it can be masked by various symptoms such as recurrent aspiration pneumonia, fever, dysphagia, and neck pain. While this complication usually occurs within the first 24 h post-surgery, it can also develop later and persist chronically in rare cases. Awareness and early recognition of this complication may improve outcomes and reduce mortality and morbidity. A 76-year-old man underwent C5-C7 ACDF in October 2017. A thorough review of the patient's postoperative condition included computed tomography (CT) and esophagogram, which were negative for signs of acute complications. The postoperative recovery was uneventful until several months post-procedure when he began to develop vague dysphagia and weight loss of unknown etiology. A CT scan was obtained 6 months postoperatively and was negative for perforation. He then underwent a battery of inconclusive procedures and scans at multiple institutions. After several months of persistent dysphagia and weight loss without a diagnosis, the patient presented to our network for further workup and treatment recommendations. Upper endoscopy was performed and showed fistulization between the esophagus and the metal hardware in the cervical spine. Esophagram demonstrated no obstruction but decreased peristalsis of the lower esophagus and lateral rightward deviation of the left upper cervical esophagus with minimal mucosal irregularities. These findings were secondary to mass effect of the cervical plate. The patient was successfully treated with a surgical approach using esophagogastroduodenoscopy (EGD) guided repair in layers and a sternocleidomastoid muscle flap. This report demonstrates a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using the dual technique.
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Affiliation(s)
- Lexi Frankel
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Amalia D. Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Gabriela Santizo
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Maximiliano Guerra
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Ghargi Gharat
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Sarmed Alnajar
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Divesh Manjani
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Andrew Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA
| | - Omar M. Rashid
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
- University of Miami, Leonard Miami School of Medicine, Miami, FL, USA
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgical Oncology, Broward Health, Fort Lauderdale, FL, USA
- TopLine MD Alliance, Fort Lauderdale, FL, USA
- Department of Surgical Oncology Memorial Health, Pembroke Pines, FL, USA
- Department of Surgical Oncology, Delray Medical Center, Delray, FL, USA
- Corresponding Author: Omar M. Rashid, Complex General Surgical Oncology, General & Robotic Surgery, TopLine MD Alliance, Fort Lauderdale, FL 33308, USA.
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3
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Peddireddy NS, Yalamanchi P, Kashlan O, Park P, Reddy RM, Chinn SB, Casper KA, Malloy KM, Stucken CL, Prince MEP, Rosko AJ, Spector ME. Anterior spinal hardware erosion of the pharyngoesophagus: A difficult reconstructive challenge-Our experience in nine patients. Clin Otolaryngol 2023; 48:264-268. [PMID: 36536995 DOI: 10.1111/coa.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/24/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Nithin S Peddireddy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Pratyusha Yalamanchi
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Osama Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Wu T, Chen H, Sun Y, Xia T, Zhou F, Lu WW. Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case. Front Bioeng Biotechnol 2022; 10:950839. [PMID: 36159686 PMCID: PMC9500315 DOI: 10.3389/fbioe.2022.950839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Little research has been reported on evaluating the safety of the fixation construct in cervical kyphosis correction. In this study, we proposed a principal-strain criterion to evaluate the safety of the fixation construct and validated the modeling method against a retrospective case of anterior cervical discectomy fusion (ACDF). From C2 to T2 vertebra bodies, fixation instruments were reconstructed and positioned as per postoperative computed tomography (CT) scans. Head weight (HW) and various moments estimated from isometric strength data were imposed onto the C2. The postoperative stability of non-surgical segments, deformations surrounding the screw trajectories, and contact slipping on zygapophysial joints were analyzed. The model was validated against the reality that the patient had a good fusion and deformity correction. The ACDF restricted the range of motions (ROMs) of cervical segments and lent stability to vertebra fusion, no failure was found in the finite element (FE) model of cervical vertebrae. The deformation surrounding the screw trajectories were concentrated to the lateral sides of trajectories, recommending that the shape of the anterior cervical plate conforming to the curvature of the vertebra and screws fully inserted into vertebrae reduced the deformation concentration around the screw trajectories.
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Affiliation(s)
- Tianchi Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - Hongyu Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Tian Xia
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feifei Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- *Correspondence: Feifei Zhou,
| | - William W. Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
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5
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Hosseini DK, Moradi R, Schoch T, Philip L, Shukla NB. Progressive Dysphagia in Patient With Cervical Plate Complicated With Posterior Pharyngeal Wall Erosion. Cureus 2022; 14:e25205. [PMID: 35611364 PMCID: PMC9124480 DOI: 10.7759/cureus.25205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/25/2022] Open
Abstract
A 58-year-old male patient with a history of Parkinson's disease and solitary cervical spinal sarcoma underwent corpectomy, a fusion of C3-C6 with cervical fixation plate placement, and stereotactic body radiation therapy, presented 18 months following surgery with dysphagia, concomitant with weakness, diplopia. The initial workup in cervical magnetic resonance imaging (MRI) revealed aerodigestive tract soft tissue enhancement. Dysphagia progressed during hospitalization, and the patient was intubated due to aspiration pneumonia and respiratory failure. Further evaluations with esophagogastroduodenoscopy (EGD) revealed posterior pharyngeal wall, upper cervical esophageal erosion, and the presence of a cervical fixation plate in the hypopharynx.
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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,Renato Salvador, Department of Surgical,
Oncological and Gastroenterological Sciences, University of Padova, Clinica
Chirurgica 3°, Via Giustiniani 2, 35128, 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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Pharyngoesophageal Damage from Hardware Extrusion at an Average of 7.5 Years After Anterior Cervical Diskectomy and Fusion: A Case Series, Discussion of Risk Factors, and Guide for Management. World Neurosurg 2022; 160:e189-e198. [PMID: 34990840 DOI: 10.1016/j.wneu.2021.12.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We present a single-institution case series of patients who experienced pharyngoesophageal damage, specifically from extruded hardware occurring at an average of 7.5 years after anterior cervical diskectomy and fusion (ACDF). METHODS A retrospective chart review was conducted of patients who had undergone ACDF with subsequent delayed pharyngoesophageal perforation or erosion from extruded hardware ≥1 year after surgery. A discussion of the literature surrounding this complication, including risk factors and management, is also presented. RESULTS Nine patients were identified (average age 58 years, 66.7% male) among a total of 4122 ACDF patients (incidence: 0.22%). Average time to injury was 7.5 years. Indications for initial ACDF were degenerative cervical disease (n = 7), ankylosing spondylitis (n = 1), and cervical fracture (n = 1). Eight patients had prior multilevel ACDF spanning 2 (n = 4), 3 (n = 1), or 4 levels (n = 2). Fusion levels for prior ACDF included C5-C7 (n = 3), C3-C7 (n = 2), C4-C7 (n = 1), C4-C6 (n = 1), C2-C5 (n = 1), and C6-C7 (n = 1). Pharyngoesophageal injuries included esophageal perforation (n = 3), pharyngeal perforation (n = 2), esophageal erosion (n = 3), and pharyngoesophageal erosion (n = 1). In most (n = 6) cases, the cause of pharyngoesophageal damage was due to ≥1 extruded screws. Dysphagia (n = 8) was the most common presenting symptom. For perforations (n = 5), 2 repairs used a rotational flap to reinforce a primary closure; the other 3 cases were repaired via primary closure. CONCLUSIONS Pharyngoesophageal damage caused by extruded hardware may occur several years after ACDF. These delayed complications are difficult to predict. Proper screw placement may be the most important factor for minimizing the chances of this potentially devastating complication, particularly with multilevel constructs.
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Modi HN, Shreshtha U, Patel U, Kotecha H, Patel MD, Dileep P. Esophageal Perforation After Anterior Cervical Surgery: A Case Report and Literature Review. Clin Spine Surg 2022; 35:49-58. [PMID: 34232154 DOI: 10.1097/bsd.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
SUMMARY AND BACKGROUND Esophageal perforation (EP) after anterior cervical surgery is a rare but potentially life-threatening condition. EP caused by malpositioned implants in cervical spine injury with multiple comorbidities is challenging to treat simultaneously. STUDY This was a case report study. PURPOSE OF STUDY The aim of this study was to present successful treatment of EP in a subluxated C5-C6 level with implant failure, infection, septicemia, and comorbidities. The aim was to emphasize the need for a multispecialty approach while treating serious complications. CASE A 72-year-old woman presented to the ER with a history of operated cervical spine a week ago and having breathlessness, fever, wound infection, and tracheostomy in situ. After primary investigations, the patient was initially treated in the intensive care unit, where bleeding from the tracheostomy site was noticed. Upon endoscopy, EP was diagnosed due to implant failure. She was operated for revision cervical spine surgery (drainage of pus with anterior and posterior cervical fixation) and percutaneous endoscopic gastrostomy tube insertion (esophageal diversion). On exploration of EP, a decision was made to perform conservative treatment as initial tag sutures did not hold due to infection. Postoperatively, the patient developed rectal bleed 3 times, which was ultimately treated with cecal bleed embolization. The infected cervical wound was managed with an open dressing. The patient was managed with intermittent assisted ventilation through tracheostomy postoperatively. Barium swallow at 10 weeks confirmed healing of EP and oral feed was started. Tracheostomy closure was performed once the wound had healed, and the patient was discharged with improved neurology at 12 weeks. CONCLUSIONS Perioperative problems after cervical surgery such as breathing difficulty, wound discharge, and worsening of neurology may lead to suspicion of underlying EP due to implant failure. Upper gastrointestinal endoscopy needs to be considered for a prompt diagnosis. Revision spine surgery with treatment of perforation simultaneously and maintenance of enteral nutrition through a percutaneous endoscopic gastrostomy tube with a multispecialty approach is recommended for this potentially life-threatening condition.
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Affiliation(s)
- Hitesh N Modi
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | - Utsab Shreshtha
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | - Udit Patel
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | | | | | - Pratibha Dileep
- Critical Care Medicine and Pulmonology, Zydus Hospital, Ahmedabad, Gujarat, India
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Yang JH, Tuano KR, Finn M, Weyant M, Chong TW, Mathes DW. Successful repair of chronic esophageal perforation due to hardware migration with buttressing free gracilis flap: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holy M, MacDowall A, Sigmundsson FG, Olerud C. Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial. Trials 2021; 22:607. [PMID: 34496941 PMCID: PMC8425018 DOI: 10.1186/s13063-021-05492-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50–55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) Methods A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as “active control.” The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. Discussion Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation. Trial registration ClinicalTrials.gov NCT04177849. Registered on November 26, 2019
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Affiliation(s)
- Marek Holy
- Department of Orthopedic Surgery, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden.
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Freyr Gauti Sigmundsson
- Department of Orthopedic Surgery, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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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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12
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A new "Ice Globe" method for dilating leaking cervical esophageal strictures. Ann Thorac Surg 2021; 113:e389-e391. [PMID: 34487712 DOI: 10.1016/j.athoracsur.2021.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022]
Abstract
An esophageal stricture may develop during healing of a large esophageal perforation. When such a stricture occurs, mechanical dilatation is the treatment of choice. As in our case, if a cervical esophageal stricture and leakage are present together, the treatment becomes even more challenging. As a new treatment method, we made spherical ice globes of various sizes using molds created with a 3D printer to treat the esophageal stricture and prevent its progression. This method can be used to safely treat leaking cervical esophageal strictures. A step-by-step of how to do it has been described.
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13
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Park JS. Esophageal perforation associated with anterior cervical discectomy and fusion: Case series and a review of the literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Dantas FLR, Dantas F, Mendes PD, Sandes BL, Fonseca Filho G. Primary Repair of Esophageal Perforation Following Anterior Cervical Fusion. Cureus 2020; 12:e11590. [PMID: 33364112 PMCID: PMC7749799 DOI: 10.7759/cureus.11590] [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] [Indexed: 11/21/2022] Open
Abstract
Introduction Anterior cervical fusion has been performed safely and effectively for decades for the treatment of multiple pathologies, with low rates of morbidity and mortality. Esophageal perforation is a rare but potentially serious complication of anterior cervical spine approaches. There is no consensus regarding the best treatment strategies for this complication. Objectives To determine the prevalence of esophageal perforation following anterior cervical fusion in a single institution and to describe two cases of this complication that were treated with primary repair. Methods We retrospectively analyzed all consecutive patients who underwent anterior cervical fusion in a single private institution from January 1999 to August 2017. Patients who developed esophageal perforation per- or postoperatively were included in the analysis. Results A total of 830 anterior cervical fusion surgeries were performed during the analyzed period. Two cases (0.24%), both of male patients, were complicated by esophageal perforation, one intraoperatively and the other four years after the first surgery. Both patients were treated with primary esophageal repair, and good outcomes were obtained. Conclusion Primary repair is a therapeutic option in cases of esophageal perforation after anterior cervical fusion. Satisfactory results were obtained in both cases. Further studies are necessary to elucidate the best therapeutic options for this rare complication.
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Affiliation(s)
| | - François Dantas
- Neurological Surgery, Biocor Instituto, Belo Horizonte, BRA.,Neurological Surgery, Hospital Vila da Serra, Belo Horizonte, BRA
| | | | - Bruno L Sandes
- Neurological Surgery, Biocor Instituto, Belo Horizonte, BRA
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Oraee-Yazdani S, Golmohammadi M, Akhlaghpasand M, Oraee-Yazdani M. Covering of Plate after Anterior Cervical Fusion in Patients with Complete Spinal Cord Injury to Prevent Esophageal Injury: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2020; 81:546-548. [PMID: 32911553 DOI: 10.1055/s-0040-1710547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Esophageal injury after anterior corpectomy and fusion is a rare but life-threatening complication. It may cause mediastinitis due to anatomical continuity between the retropharyngeal space and the mediastinum, with reported high mortality rates. The acute and subacute injuries are most commonly of iatrogenic origin, while late perforation has been described several weeks to years later as a result of continuous friction or pressure of the instruments against the posterior wall of the esophagus, leading to ischemia and necrosis. This phenomenon is more common among quadriplegic patients who have undergone corpectomy and insertion of expandable or mesh cages and plate probably due to chronic erosion by hardware at the supine position. METHODS Since 2015, we have applied the technique of using a patch of autologous fascia lata to cover the anterior cervical plate by suturing to the longus colli muscles in 58 quadriplegic patients; the mean follow-up was 35.2 (28-41) months. RESULTS Since we started using this procedure, based on our follow-up at our center, there have been no cases of late esophageal perforation among quadriplegic patients. CONCLUSION As a technical note, it seems like this method would be able to reduce the prevalence of esophagus injury among quadriplegic patients. However, to substantiate the efficacy of this technique, long-term follow-up and larger sample size are needed because esophageal injury occurs rarely.
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Affiliation(s)
- Saeed Oraee-Yazdani
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Golmohammadi
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadhosein Akhlaghpasand
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Oraee-Yazdani
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mediastinal fluid as a predictor for esophageal perforation as the cause of pneumomediastinum. Emerg Radiol 2020; 28:233-238. [PMID: 32813157 DOI: 10.1007/s10140-020-01841-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Pneumomediastinum is not an uncommon finding on emergency CTs and is seen in a variety of settings, including acute trauma, recent repeated emesis and recent thoracic surgery, and after EGD (Kouritas et al. J Thorac Dis 7(Suppl 1):S44-S49, 2015). The purpose of this study was to examine cases of CT pneumomediastinum for distinguishing features which could support or exclude esophageal injury as a cause, which in turn could help guide evaluation of these patients. METHODS CT chest scans showing pneumomediastinum performed in the emergency department between January 2013 and December 2018 were included. The presence or absence of fluid within the mediastinal compartments was correlated with esophageal perforation and subdivided into the clinical scenarios of trauma, suspected Boerhaave's syndrome, recent surgery or EGD, and other. Accuracy of this finding was compared with fluoroscopic esophagography. RESULTS Twenty-two cases of esophageal perforation were identified out of a total of 324 included cases. The cases were subdivided into four categories: trauma, suspected Boerhaave syndrome, suspected iatrogenic perforation from recent procedure or surgery, and other. Two hundred fourteen cases of pneumomediastinum occurred in the setting of trauma, and 2 had esophageal perforation. Both showed mediastinal fluid. Twenty-two cases had mediastinal fluid without perforation. Seventeen cases of pneumomediastinum occurred in the setting of suspected Boerhaaves, and 3 had esophageal perforation. Every case with esophageal perforation had mediastinal fluid, and every case without perforation had no mediastinal fluid. Nine cases of pneumomediastinum occurred in the setting of suspected iatrogenic perforation after recent surgery or procedure. Six cases had esophageal perforation, and 5 of these had mediastinal fluid. All three cases without perforation also had mediastinal fluid. Eighty-six cases were classified as other and included a variety of clinical histories. This category contained 8 esophageal perforations, 7 of which had mediastinal fluid. One case of mediastinal fluid was not associated with esophageal perforation in this category. CONCLUSION The presence of mediastinal fluid, specifically within the visceral compartment, strongly suggests esophageal injury, and its absence strongly argues against it. An important caveat is in the setting of recent surgery, in which mediastinal fluid can be seen normally. An esophagography study can supplement the evaluation if there is a discrepancy between the clinical suspicion and the original CT findings.
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Poissonnet V, Lubrano V, Sadeler A, Chabrillac E. Delayed pharyngo-oesophageal perforation after anterior cervical spine surgery. Neurochirurgie 2020; 66:414-416. [PMID: 32623058 DOI: 10.1016/j.neuchi.2020.04.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- V Poissonnet
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France.
| | - V Lubrano
- Department of Neurosurgery, Toulouse University Hospital, Hôpital Pierre Paul Riquet, place du Dr Baylac, 31100 Toulouse, France
| | - A Sadeler
- Department of ENT-Head and Neck Surgery, Polyclinique de l'Ormeau, 28, boulevard du 8 mai 1945, 65000 Tarbes, France
| | - E Chabrillac
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
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Kulkarni AG, Kunder TS, Khandge AV. Nasogastric tube in anterior cervical spine surgery, is it necessary? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 10:199-202. [PMID: 32089611 PMCID: PMC7008665 DOI: 10.4103/jcvjs.jcvjs_83_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/01/2019] [Indexed: 12/08/2022] Open
Abstract
Background: The aim of this article was to verify the utility of nasogastric (NG) tube in primary anterior cervical surgeries. Palpating and identifying the NG tube introduced during induction is one of the ways of preventing esophageal injuries during surgery. It may also be used as a conduit for postoperative feeding. However, the use of NG tube is not without complications. Esophageal perforation is one of them, with an incidence of 0.3%. Materials and Methods: A retrospective observational study was performed of patients who underwent a primary anterior cervical spine surgery from January 2007 to July 2017 by a single surgeon. The indications were degenerative, trauma, infection, and neoplasia. NG tube was avoided in all cases. The patients were followed for 6 months. Results: Our study included 356 patients (201 males and 155 females), with a mean age of 43.6 years (18–92 years) and a mean follow-up of 6 months. We had only one case of esophageal perforation (0.28%) attributed to a traumatic burst fracture. Conclusions: This study indicates that the use of a NG tube in primary anterior cervical spine surgery can be avoided. Comprehensive knowledge of anatomy and meticulous dissection may avoid the disastrous complication of esophageal rupture. This way the discomfort and complications associated with NG tube can be avoided.
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Affiliation(s)
- Arvind Gopalrao Kulkarni
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Tushar Satish Kunder
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ashwinkumar V Khandge
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Nakano A, Nakaya Y, Fujishiro T, Hayama S, Obo T, Baba I, Neo M. Assessing the Intraoperative Risk of Esophageal Perforation during Anterior Cervical Spine Surgery: A Study Using Intraoperative Computed Tomography. Spine Surg Relat Res 2019; 4:124-129. [PMID: 32405557 PMCID: PMC7217672 DOI: 10.22603/ssrr.2019-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Using intraoperative computed tomography (iCT), we aimed to clarify the course of the esophagus and pharynx during anterior cervical spine surgery to estimate the risk of intraoperative injury. Methods Sixteen patients who underwent anterior cervical spine surgery with intraoperative CT for registration of a navigation system without release of blade retraction were included. To investigate the status of the retracted esophagus and pharynx, the distance between the nasogastric tube and center of the vertebra (NVD) was measured at each disc and vertebral level (C4-7) using axial CT. The location of the cricoid cartilage, which may affect the shift of the esophagus and pharynx, was noted. Presence or absence of contact between the esophagus and the edge of the surgical blade was investigated. Results The NVDs were 28.0, 28.3, 28.9, 27.2, 24.7, 19.9, and 13.8 mm at C4, C4/5, C5, C5/6, C6, C6/7, and C7, respectively; NVDs at C6/7 or more caudal levels were significantly shorter than those at C6 or more cranial levels (P < 0.001). The cricoid cartilage was observed at the C4-C5/6 level. Esophageal contact with the edge of the blade was observed in nine cases at C6 or more caudal levels. Conclusions The esophagus, which was placed at C6 or more caudal levels, was directly retracted by the blade. Nevertheless, the pharynx, which was placed at C6 or more cranial levels, was mostly retracted with the cricoid cartilage. Thus, the risk of direct esophageal injury was higher at C6 or more caudal levels than at cranial levels.
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Affiliation(s)
- Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Ichiro Baba
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Treatment considerations for cervical and cervicothoracic spondylodiscitis associated with esophageal fistula due to cancer history or accidental injury: a 9-patient case series. Acta Neurochir (Wien) 2019; 161:1877-1886. [PMID: 31256278 DOI: 10.1007/s00701-019-03985-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The combination of cervical spondylodiscitis and esophageal fistula is rare but life-threatening. Due to both the rarity of these conditions' coincidence and the complexity and heterogeneity of individual cases, there is no optimal treatment or management approach. The aims of this study are to obtain an overview of patients' outcomes and to discuss treatment options. METHOD This study is a retrospective analysis of patients who presented with cervical spondylodiscitis and associated esophageal fistula between January 2010 and November 2018. We examined reports of 59 patients who suffered from cervical spondylodiscitis and included nine patients (15.25%) who had an esophageal fistula as the underlying cause. We assessed clinical findings, treatment, and outcome. RESULTS Three of the nine patients were female, and the mean age of the sample was 64.56 years. Six of the patients had a history of esophagopharyngeal cancer and had undergone tumor resection followed by radiotherapy. Two of the remaining patients' fistulas were caused by an iatrogenic injury during cervical spine surgery and a swallowed toothpick; in the final case, the origin remained unclear. Five patients presented with tetraparesis or tetraplegia, and the other four patients were neurologically intact. In seven cases, dorsal instrumentation was initially performed. Three patients secondarily received a ventral approach for debridement, and one received explantation of the ventral implants. Two patients died during the hospital stay, and three were transferred to a palliative care unit. Thus, the spondylodiscitis and esophageal fistula were cured in only four patients. At discharge, two patients were neurologically intact, two others remained in tetraparesis. CONCLUSIONS Cervical spondylodiscitis in association with an esophageal fistula carries high morbidity and high mortality. Because patients whose infections are not cured have high morbidity, we recommend using interdisciplinary and individual management, including definite surgical treatment of the discitis and fistula, in every case.
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Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series. Int J Otolaryngol 2019; 2019:7682654. [PMID: 31341480 PMCID: PMC6614980 DOI: 10.1155/2019/7682654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 01/10/2023] Open
Abstract
Context. This case series discusses surgical management of esophageal perforations that occurred following cervical spine hardware placement. Purpose. (1) Determine presenting symptoms of esophageal perforation after anterior cervical spine hardware placement. (2) Discuss surgical management of these resulting esophageal perforation complications. Design/Setting. Case series of six patients at a tertiary-care, academic medical center. Patient Sample. Six patients with pharyngoesophageal perforations following anterior cervical spine surgery (ACSS). Outcome Measures. Date of ACSS, indication for ACSS, level of hardware, location of esophageal or pharyngeal injury, symptoms at presentation, surgical intervention, type of reconstruction flap, wound culture flora, and antibiotic choice. Methods. A retrospective review of patients with an esophageal or hypopharyngeal injury in the setting of prior ACSS managed by the otolaryngology service at a tertiary, academic center between January 2015 and January 2019. Results. Six patients who experienced pharyngoesophageal perforation following ACSS are included in this study. Range of presentation was two weeks to eight years following initial hardware placement. Five patients presented with an abscess and all had evidence of perforation on initial CT or esophagram. All patients underwent repair with a sternocleidomastoid flap with two patients eventually requiring an additional pectoralis myofascial flap for a persistent esophageal leak. Five patients eventually attained ability to tolerate oral nutrition. An algorithm detailing surgical reconstructive management is proposed. Conclusions. Esophageal perforations in the setting of prior ACSS are challenging clinical problems faced by otolaryngologists. Consideration should be given to early drainage of abscesses and spine surgery evaluation. Spinal hardware removal is recommended whenever possible. Utilization of a pedicled muscle flap reinforces primary closure and allows coverage of the vertebral bony defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are necessary to optimize esophageal perforation repair.
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Volkow-Fernández P, Islas-Muñoz B, Santillán-Doherty P, Estrada-Lobato E, Alva-López L, Ávila-Ramírez J. Successive complications after anterior cervical fixation: pharyngoesophageal diverticulum, fistulization, and cervical spondylitis by Streptococcus milleri - case report and literature review. J Med Case Rep 2019; 13:129. [PMID: 31036083 PMCID: PMC6489233 DOI: 10.1186/s13256-019-2037-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 02/28/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Pharyngoesophageal diverticulum is an uncommon complication after anterior cervical discectomy and fusion surgery. Case presentation Our patient was a 48-year-old woman with two previous cervical surgeries with fixation of C4-C5 and C5-C6, the last one in 2003. Two years after surgery, she presented with arthralgia, arthritis, chills, and fluctuating rash. In 2007, she presented with dysphagia, halitosis, and sputum production. She was diagnosed with a pharyngoesophageal diverticulum with a fistula to C6 vertebra and secondary spondylitis. She was taken for open surgery with removal of screws and plates, cricopharyngeal myotomy, and esophageal repair. Streptococcus milleri grew in tissue and osteosynthetic material. She received 4 months of amoxicillin and probenecid and had a complete recovery. Since 1991, 19 similar cases have been reported with one fatality. To our knowledge, this is the first reported case of diverticulum complicated with fistula and secondary spondylitis. Conclusions In patients with a history of anterior cervical discectomy and fusion complaining of dysphagia, even years after surgery, it is mandatory to perform an esophagogram. This symptom was referred to in 88% of the cases reported in the literature.
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Affiliation(s)
- Patricia Volkow-Fernández
- Infectious Disease Department, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA), San Fernando 22, Col. Sección XVI, Tlalpan, México City, DF, 14080, México.
| | - Beda Islas-Muñoz
- Infectious Disease Department, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA), San Fernando 22, Col. Sección XVI, Tlalpan, México City, DF, 14080, México
| | | | - Enrique Estrada-Lobato
- Nuclear Medicine Department, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA), Mexico City, Mexico
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A technical case report on use of tubular retractors for anterior cervical spine surgery. 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 2017; 27:1454-1459. [PMID: 29260308 DOI: 10.1007/s00586-017-5423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/23/2017] [Accepted: 12/09/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. METHODS First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. RESULTS No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. CONCLUSION Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.
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