The treatment of pharyngoesophageal perforation following anterior cervical spine intervention

Aslıer, Mustafa; Doğan, Ersoy; Ecevit, Mustafa Cenk; Erdağ, Taner Kemal; İkiz, Ahmet Ömer

doi:10.1016/j.anl.2015.10.008

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Esophageal fistula may be the first and most worrying complication for cervical surgeons. Esophageal fistula usually presents with symptoms of odynophagia, dysphagia, high fever, as well as salivary leakage from the incision site after eating [14]. Laboratory and radiological examinations such as MRI, esophageal radiography, and esophagoscopy are crucial in obtaining evidence for its diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…A statistically significant increased risk of dysphagia has been reported after ACDF [ 13 ]. 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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…After eligibility assessment a total of 68 studies were included (Figure 3). 5, There were 62 case reports and case series (�5 patients) 5,33,34,59,[61][62][63][64][65][66][67][68]72,73 and 6 retrospective studies (>5 patients). 39,42,63,65,73,74 All included studies were level 4 evidence.…”

Section: Literature Reviewmentioning

confidence: 99%

Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature

Moletta

Pierobon

Salvador

et al. 2021

Global Spine Journal

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Study Design: Case series and systematic review of the Literature. Objectives: Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. Methods: Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. Results: Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. Conclusions: PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients

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“…Incidence in anterior surgical spine surgery is 0.25-1.49% [22,23]. It is iatrogenic in at least 70% of cases, implicating surgical instruments [24]. It may show early or late symptomatology, with cervical or retrosternal pain, hematemesis, odynophagia or dysphagia [25][26][27].…”

Section: Particular Case Of Early Pharyngoesophageal or Pharyngeal Pementioning

confidence: 99%

“…Other teams use complementary posterior cervical fixation or external contention by occipito-cervico-thoracic brace [28]. Simple ablation seems to suffice in late perforation by esophageal compression due to material migration [24].…”

Section: Particular Case Of Early Pharyngoesophageal or Pharyngeal Pementioning

confidence: 99%

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

Gamain

Coulomb

Houzir³

et al. 2019

Orthopaedics & Traumatology: Surgery & Research

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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.

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The treatment of pharyngoesophageal perforation following anterior cervical spine intervention

Cited by 5 publications

References 15 publications

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

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

Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature

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

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