Anterior cervical spine surgical site infection and pharyngoesophageal perforation. Ten-year incidence in 1475 patients

Abstract

Background: Surgical site infection is reputed to be infrequent in anterior cervical spine surgery. Data on pathophysiological mechanism and risk factors are sparse. The relationship between local site infection and pharyngoesophageal perforation is unclear. The present study aimed: (1) to estimate the incidence of surgical site infection in anterior cervical spine surgery, (2) estimate the incidence of associated pharyngoesophageal perforation, and (3) suggest a decision-tree for early management of this twofold issue. Hypothesis: Although with very low incidence, anterior cervical spine surgical site infection and pharyn-goesophageal perforation are frequently associated. Material and methods: A 2-center retrospective study included all anterior cervical spine surgeries between January 1, 2007 and December 31, 2016. Data were provided by the two medical information departments. Patients undergoing anterior revision surgery on the cervical spine were included. Files were analyzed to determine whether the revision surgery was secondary to surgical site infection. Results: In total, 1475 patients with anterior cervical spine surgery were identified: 1180 in center A (80%) and 295 in center B (20%). The rate of revision surgery for surgical site infection was 0.34% (5/1475). There were 3 cases of pharyngoesophageal perforation (0.2%). Discussion: The incidence of revision surgery for anterior cervical spine surgical site infection was comparable to rates in the international literature (0.07-1.6%). An association between surgical site infection and pharyngoesophageal perforation was frequent, but not statistically significant. This complication is extremely serious, requiring urgent multidisciplinary management.

Mechanisms of Immune Evasion and Bone Tissue Colonization That Make Staphylococcus aureus the Primary Pathogen in Osteomyelitis

“…Moreover, their quality of life is among the poorest of the osteomyelitis patients as two-thirds of lower extremity amputations are associated with DFI [13,23,24]. Finally, the post-operative occurrence rate of OMS is between 0.3 and 20%, a prevalence rate that is higher than all of the other classes of orthopaedic infections [14].…”

Postoperative complications associated with anterior cervical discectomy and three years follow-up

“…During an anterior cervical approach to the spine, the infection can be associated with another severe complication, iatrogenic injury to the esophagus during surgery. Its incidence is described in the literature as 0.3-3.4 % (7,11,12). Gamain et al (12), in a set of 1475 patients after anterior cervical discectomies, recorded 5 infectious complications, of which only 3 cases were associated with esophageal perforation, but they did not record the death of the patients.…”

Esophageal perforation after anterior cervical spine surgery

“…However, thus far, there is a dearth of data in the literature to guide wound management following surgical intervention. 4 , 5 , 6 , 7 , 8 This is the first study that has examined the influence of a wound management approach on postoperative outcomes of esophageal perforation following ACSS. Results from our study strongly suggest that an open wound management approach should be added to the surgical management algorithm.…”