A novel treatment approach for esophageal perforation post-anterior cervical discectomy and fusion: A case report

Abstract

Anterior cervical discectomy and fusion (ACDF) is a common spinal surgery performed in the United States to achieve spinal cord and nerve root decompression. Our case presentation describes a rare presentation of esophageal perforation post-ACDF requiring repair with a novel surgical approach. A 59-year-old male with intractable cervicalgia and evidence of C7 radiculopathy supported by cervical MRI showing moderate to severe left neural foraminal narrowing at C6-C7 underwent ACDF at an outside institution without intraoperative complications. On postoperative day four, the patient reported to the emergency department due to a 3-day history of fever, encephalopathy, purulent drainage from the incision site, and erythema with tenderness over the incision site down to the anterior chest wall. Cervical MRI and CT confirmed extensive cellulitis/fasciitis and large-volume subcutaneous soft tissue emphysema. CT esophagram showed a right posterior esophageal leak at C6-C7 with esophagocutaneous fistula. Multidisciplinary treatment included neurosurgical washout and drain placement followed by esophageal repair via esophagogastroduodenoscopy (EGD) utilizing over-the-scope clip (OTSC) to repair the esophagocutaneous fistula. Early identification and treatment of esophageal perforation is critical, as mediastinitis and cardiopulmonary collapse with high mortality may result despite current treatment regimens. We describe a successful novel approach to treating esophageal perforation with surgical washout and primary fistula closure through EGD with OTSC. Further research is needed to investigate potential risk factors and treatment strategies for esophageal perforation following ACDF.