Successive complications after anterior cervical fixation: pharyngoesophageal diverticulum, fistulization, and cervical spondylitis by Streptococcus milleri – case report and literature review

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.

Iatrogenic pharyngo‐esophageal diverticulum post‐anterior cervical discectomy and fusion: A case report and review of literature

“…Nine out of the 23 cases have reported the development of symptoms over 2 years after ACDF. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 However, in the literature, postoperative dysphagia ranged from immediate postoperative discovery to delayed discovery 20 years postoperatively. 3 , 7 In our case, dysphagia developed 1 year after the surgery.…”

Magnet-assisted endoscopic diverticulotomy for an esophageal diverticulum after anterior cervical spine surgery: First case report

“…It does not allow the removal of the plate and screws. In additionally, in patients who already have a fistula and an infection of the surrounding tissues 6 , the endoscopic pathway may not allow for adequate debridement to control and resolve the infection. We believe that in the absence of fistula or a local infection, when the plate and screws are not displaced or loose, their removal is not imperative.…”

“…There is no study in the literature that compares the various treatment modalities for pharyngoesophageal diverticulum after an anterior approach to the cervical spine. In most of the cases reported, conventional surgery was performed and was very effective 6 7 . There are few published cases on endoscopic treatment of this diverticulum.…”

Treatment of type II odontoid fracture in the elderly

“…We identified 30 cases of zenker’s diverticulum formation after anterior cervical surgery but not in case of ACSF for Odontoid fracture [ 9 , 10 ]. Whilst dysphagia was a recognized complication following ACSF.…”