Esophageal Complications after Anterior Cervical Spine Fixation

Abstract

Background; Esophageal perforation may occur spontaneously, induced by a foreign body, or caused by direct trauma or iatrogenically. Anterior approach to the cervical spine surgery which was introduced in the late 1950s and extensively used since its description, is considered a known etiology for esophageal injury.

Patients and methods: We retrospectively reviewed cases of esophageal perforation that was encountered in our hospital as primary cases or referred from other hospital in between the years 2008 to 2019. All cases with esophageal injury were included. Any patient whose injury caused by other than spinal fixation was excluded.

Result: Eleven cases were encountered with a different time of presentation after surgery ranging from intraoperative discovery to 7 years post spinal fixation. Presenting symptoms were dysphagia, neck pain, persistent discharge from the cervical wound with or without food particles and odynophagia. Management plans varied from surgical intervention with primary repair, debridement, drainage, to conservative management. PEP repair was attempted in all and done in nine patients. Two patients only were treated conservatively without esophageal repair as the tear was small and in the early postoperative period. Supportive treatment in the form of frequent wound care, broad spectrum IV antibiotics, NPO and adequate feeding via alternative routes were secured as well.

Conclusion: Esophageal injury, although uncommon in anterior spinal approach, still considered a life-threatening complication and need a low threshold of suspicion from the surgeon with prompt and targeted intervention as there is no definite guide-line for the management.