Esophageal Injury After Anterior Cervical Spine Fixation: What Can Thoracic Surgeons Offer?

Abstract

Background: The anterior approach for cervical spine surgery was introduced in the late 1950's and was then extensively used with a known considered risk for an esophageal injury.

Objective: Therefore, we designed this study to look into our institution's experience in the treatment of esophageal injury post cervical spine fixation looking at possible causes, presentation and risk factors.

Methods: A retrospective analysis of esophageal perforation cases secondary to cervical spine fixation, encountered in King Fahad hospital of the University (Eastern province, Dammam, Saudi Arabia) in between (2008-2019) were studied.

Results: The patients included were 11, in which the most common presenting symptoms were dysphagia, neck pain, persistent discharge from the cervical wound with or without food particles and odynophagia, while the mean period for presentation was 358.9 days (ranging from 4 to 2555 days). The pharyngo-esophageal perforation repair was done in 9 patients, while 2 patients were treated conservatively. In addition, supportive measures (i.e., frequent wound care, broad spectrum intravenous antibiotics, non per oral and adequate feeding via alternative routes) were done for all patients.

Conclusion: Esophageal injury, although uncommon in anterior spinal approach, still considered a life-threatening complication and need a low threshold of suspicion.