Diagnosis and management of esophageal perforation with necrotizing fasciitis in traumatic cervical spine injuries: illustrative case.

Abstract

Background: Esophageal perforation is a rare but deadly complication of cervical spine fractures. Early identification can be difficult but is imperative for proper treatment and prevention of life-threatening infection. Once diagnosed, surgical drainage and broad-spectrum antibiotics can yield positive outcomes. The authors present a successfully managed case of cervical spine fracture with associated esophageal perforation and necrotizing fasciitis as well as an extensive literature review.

Observations: An 87-year-old male with a previous cervical laminectomy presented to the emergency department with shortness of breath after a ground-level fall. Initial CT imaging of the cervical spine was noted to have no abnormalities at the time, and the patient was sent home. Eight days later, he presented again with neck pain, spasm, overt hyperextension injury, and fracture of the C7 vertebra, which was seen on CT. Initial surgical fixation was aborted due to the discovery of necrotizing fasciitis resulting from esophageal perforation. After surgical repair, debridement, and antibiotics, the fracture was stabilized via C2-T3 posterior segmental instrumented fusion. Following a complex hospital course, the patient was ultimately discharged following inpatient rehabilitation at his neurological baseline.

Lessons: Esophageal perforation and necrotizing fasciitis from cervical spine injuries can be deadly if not diagnosed and managed early. A high level of suspicion should be maintained with disruption of the anterior column of the cervical spine. A combination of surgical and medical management can yield successful treatment. https://thejns.org/doi/10.3171/CASE24720.