A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct

Quadri, Syed A.; Capua, John Di; Ramakrishnan, Vivek; Sweiss, Raed; Cabanne, Marc; Noel, Jerry; Siddiqi, Javed

doi:10.3171/2016.10.spine16560

Cited by 29 publications

(28 citation statements)

References 37 publications

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“…Several studies have reported an incidence of pedicle screw‐related complications from 1% up to 54%, including infections, neurological deficits, wound revisions, blood drainage and so on 44–47 . Most previous literature suggested that RA could decrease complication rates.…”

Section: Discussionmentioning

confidence: 99%

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The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

“…[44][45][46][47] Most previous literature suggested thatRA could decrease complication rates. Kantelhardt et al found a significantly lower post-operative infection rate of 2.7% in RA procedures versus 10.7% in FA procedures.…”

mentioning

confidence: 99%

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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“…The incidence of pharyngoesophageal perforation varies between 0.25 and 1.49% [14]. Other complications of soft-tissue injury [8], nerve injury, loss of fixation [9], degeneration of adjacent segments [10], screw plate migration and pullout, and pharyngeal perforation [12] have been documented.…”

Section: Discussionmentioning

confidence: 99%

“…The use of plates in ACDF has shown improved clinical outcomes, fusion rates, stability and prevention of graft dislodgement as well as the restoration of the cervical physiological curvature [ 7 ]. Despite the relative safety and efficacy of ACDF, many complications such as soft-tissue injury [ 8 ], loss of fixation [ 9 ], degeneration of adjacent segments [ 10 ], dysphagia [ 11 ] and pharyngeal perforation [ 12 ] have been reported.…”

Section: Introductionmentioning

confidence: 99%

A rare case report of laryngopharyngeal polyp formation following anterior cervical discectomy and fusion (ACDF)

et al. 2020

BMC Musculoskelet Disord

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Background Anterior Cervical Discectomy and Fusion (ACDF) has been regarded as the “gold standard” treatment of cervical spondylosis. Though it has good outcomes, many complications still exist, such as loss of fixation, degeneration of adjacent segments, dysphagia and pharyngeal perforation. In view of current literature, this study is the first to report a case of laryngopharyngeal polyp following ACDF. Case presentation A 63 year old male patient suffered from cervical spine hyperextension after trauma accompanied by numbness of the hands and decreased muscle strength in both upper limbs. Anterior cervical fusion surgery was performed in our hospital, after which the patient’s upper limb numbness disappeared and muscle strength returned to normal. In the fifth month after surgery, the patient developed a sore throat and dysphagia. Symptoms gradually worsened, and the patient was hospitalized four times, subsequently undergoing tracheotomy, internal fixation removal, and polypectomy. The patient’s pronunciation, breathing, and swallowing functions returned to normal, and the incision healed. After a one-year follow-up, the polyp did not recur. Conclusions Laryngopharyngeal polyp formation following ACDF has yet to be reported in literature. By excluding esophageal fistula as soon as possible, removing internal fixation and polypectomy serves as the best treatment in relieving patient symptoms.

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“…We recommend using bulkier tissue flaps such as the pectoralis flap in the setting of esophageal perforations >2cm, vertebral body defects greater than 5mm, or SCM flaps that have failed to resolve the esophageal perforation [1, 11]. For a large esophageal perforation (>2cm) or in situation where the vertebral body defect is large (3x3cm) or deep/protruding (>5mm), we recommend placing a bulky myofascial flap to sufficiently reinforce the esophageal perforation repair site while obliterating the vertebral body defect.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series

Lee

Appelbaum

Sheen

et al. 2019

International Journal of Otolaryngology

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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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A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct

Cited by 29 publications

References 37 publications

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

A rare case report of laryngopharyngeal polyp formation following anterior cervical discectomy and fusion (ACDF)

Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series

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