Asian Spine J.  2019 Dec;13(6):976-983. 10.31616/asj.2018.0316.

Esophageal Perforation after Anterior Cervical Spine Surgery

Affiliations
  • 1Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.
  • 2Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. spinepjb@catholic.ac.kr
  • 3Department of Orthopedic Surgery, Chonbuk National University Hospital, Jeonju, Korea.
  • 4Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Korea.
  • 5Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea.
  • 6Department of Orthopaedic Surgery, Barun Mind Hospital, Daejeon, Korea.

Abstract

STUDY DESIGN: Retrospective case analyses. PURPOSE: To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis. OVERVIEW OF LITERATURE: To date, few studies have addressed these issues.
METHODS
A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups.
RESULTS
In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis.
CONCLUSIONS
The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

Keyword

Esophageal perforation; Anterior surgery; Cervical spine
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