Traction Diverticulum of the Hypopharynx following Anterior Cervical Spine Surgery

Goffart, Y; Lenelle, Jacques; Moreau, Pierre Emmanuel; Boverie, Jean

doi:10.1177/000348949110001012

Cited by 28 publications

(29 citation statements)

References 15 publications

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“…It is an acquired pouch which is located proximally to the upper esophageal sphincter, usually on the posterior hypopharyngeal wall [4]. Pharyngoesophageal diverticulum is mostly found among elderly people who are in their 70s or 80s, and only a few authors have reported it as a much rarer complication of anterior spine surgery [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

et al. 2010

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Pharyngoesophageal diverticulum after anterior cervical spine surgery is a rarely reported but potentially life-threatening complication. A case report of pharyngoesophageal diverticulum 7 years after anterior cervical spine surgery is presented. The patient suffered from dysphagia, odynophagia, recurrent fever, weight loss, and also an impressive bulging in the neck with swallowing. After careful examination and preparation, he underwent revision surgery via an open procedure, had the implants removed, pouch excised, and esophagus reconstructed reinforced by a sternohyoid muscle flap as well as an omohyoid muscle flap. The post-operative period was uneventful, and he experienced a satisfactory recovery. At last follow up, 2.5 years post surgery, the patient remained symptom free. Upon review of the literature, only six such previous reports with seven cases were found. Diagnostic tools, possible mechanism, correlative factors and treatment are discussed. This patient was fortunate that although his symptoms developed long after the initial anterior cervical operation and the pouch grew impressively large almost perforating, he still recovered well. It again proves the necessity of long-term X-ray follow up, and also reminds the surgeons to be alert of the possibility of esophageal injury even when the esophageal symptoms are mild and occur long after the initial operation.

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Section: Introductionmentioning

confidence: 99%

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

et al. 2010

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“…Given the large number of vital neural and aerodigestive structures that traverse this surgical region, it is not surprising that dysphagia has been identified as a potential complication of anterior cervical spine surgery (ACSS) [4,[6][7][8][9][10][11][12][13][14][15][16][17]. Indeed, some reports have suggested that transient dysphagia is among the most common patient complaints following ACSS [4], and that dysphagia occurs in as many as 80% of ACSS patients [12].…”

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confidence: 99%

Dysphagia following Anterior Cervical Spine Surgery

1997

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Although previous reports have identified dysphagia as a potential complication of anterior cervical spine surgery (ACSS), current understanding of the nature and etiologies of ACSS-related dysphagia remains limited. The present study was undertaken to describe the patterns of dysphagia that may occur following ACSS. Thirteen patients who exhibited new-onset dysphagia following ACSS were studied retrospectively by means of chart review and videofluoroscopic swallow study analysis. Results indicated that a variety of swallowing impairments occurred following ACSS. In 2 patients, prevertebral soft tissue swelling near the surgical site, deficient posterior pharyngeal wall movement, and impaired upper esophageal sphincter opening were the most salient videofluoroscopic findings. In another 5 patients, the pharyngeal phase of swallowing was absent or very weak, with resulting aspiration in 3 cases. In contrast, an additional 4 patients exhibited deficits primarily of the oral preparatory and oral stages of swallowing including deficient bolus formation and reduced tongue propulsive action. Finally, 2 patients exhibited impaired oral preparatory and oral phases, a weak pharyngeal swallow, as well as prevertebral swelling. Thus, a variety of swallowing deficits, due possibly to neurological and/or soft tissue injuries, may occur following ACSS.

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“…The first reported case of a traction diverticulum caused by ACSS was the result of an adherence of the hypopharyngeal mucosa to a bone graft in a patient after fusion of a C6 and C7 fracture and dislocation . Since then, 22 cases have been reported in the literature . Presentation has been varied, with some patients presenting a few months after ACSS and some identified as late as 18 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Traction diverticulum is a rare cause of postoperative dysphagia after ACSS and was first reported in 1991 by Goffart et al A traction diverticulum is different than a pulsion diverticulum in that it results from adherence of the pharyngeal or esophageal mucosa to a static source. Subsequent shearing stress from swallowing and peristalsis exacerbate the traction diverticulum, with potential for hardware erosion through the mucosa leading to exposed plates, infection, and fistula formation . Since the initial description of Zenker's‐like traction diverticulum (ZTD), various case reports have highlighted the misdiagnosis of ZTD as typical ZD, the presence of exposed cervical hardware, and patient mortality.…”

Section: Introductionmentioning

confidence: 99%

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

et al. 2019

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Objectives: A Zenker's diverticulum (ZD) is a hypopharyngeal pulsion diverticula caused by dysfunction of the cricopharyngeus muscle with herniation of hypopharyngeal mucosa through Killian's dehiscence. Anterior cervical spine surgery (ACSS) can cause a Zenker's-like traction diverticulum (ZTD) with a similar presentation but different pathophysiology. The purpose of this investigation was to compare the fluoroscopic parameters and surgical outcomes of ZTD after ACSS to those of typical ZD.Study Design: Case-control study. Methods: The charts of patients undergoing a videofluoroscopic swallow study after ACSS between January 1, 2014, and January 1, 2018, were evaluated for evidence of ZTD. Patients with ZTD were age and gender matched to persons with ZD. Fluoroscopic parameters and patient-reported outcomes were compared between groups.Results: Eleven patients with ZTD were identified. The mean pharyngeal constriction ratio (PCR) was significantly higher for persons with ZTD (0.87 [AE0.07] vs. 0.17 [AE0.08]; P < 0.05). Mean hyolaryngeal elevation was significantly less (2.5 [AE0.9] cm vs. 3.5 [AE0.7] cm) and mean diverticulum size significantly smaller (1.3 [AE1.0] cm vs. 2.3 [AE2.0] cm) for persons with ZTD (P < 0.05). Five ZTD patients had exposed hardware necessitating open approach for removal.Conclusion: We report the largest cohort of ZTD after ACSS. ZTD are smaller than traditional Zenker's and associated with more pharyngeal weakness, poorer laryngeal elevation, and worse treatment outcomes. Although these diverticula can be managed endoscopically, the high percentage of exposed cervical hardware necessitates a thorough preoperative assessment and frequent need for open management and pharyngeal repair.

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Traction Diverticulum of the Hypopharynx following Anterior Cervical Spine Surgery

Cited by 28 publications

References 15 publications

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

Dysphagia following Anterior Cervical Spine Surgery

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

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