Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-08-28 DOI:10.1097/BSD.0000000000001927

Christopher Lucasti, Charles W Stube, Francesca Viola, Danielle E Chipman, Thomas J Ryan, Emily K Vallee, Maxwell M Scott, David Kowalski, Christopher L Hamill, Joseph L Muscarella

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引用次数: 0

Abstract

Study design: Retrospective clinical case series.

Objective: The objective of our study was to analyze a series of patients with delayed esophageal perforations following anterior cervical discectomy and fusion (ACDF) and describe their presentation, causes, and the efficacy of primary esophageal repair.

Summary of background data: Delayed esophageal perforation after ACDF is a rare but significant complication.

Methods: Patients above 18 years with esophageal perforations presenting to a single otolaryngologist from 1998 to 2023 were reviewed. Seven patients met inclusion criteria. Patients were included if they had a delayed esophageal perforation with a prior ACDF. Demographics, comorbidities, length of stay, operative details, and postoperative test results were collected.

Results: The average age was 63.6±10.0 years, and 4 (57%) were female. The average time between ACDF and esophageal perforation repair was 2.25 (IQR: 7) years. Patients presented with symptoms of dysphagia, dysphonia, neck abscesses, cutaneous fistula, and/or neck pain. Proposed reasons for esophageal perforation included exposed instrumentation on endoscopy (N=2), anterior displacement of instrumentation (N=2), instrumentation malposition (N=1), failure and infection of instrumentation (N=1), and adherence of plate to pharyngoesophageal segments causing perforation upon mobilization (N=1). All patients were successfully treated with instrumentation removal followed by primary closure of the esophageal defect. The average length of follow-up from esophageal repair surgery was 464.4±443.4 days. The median length of follow-up from prior ACDF was 4.25 (IQR: 6.75) years.

Conclusions: This study demonstrates that delayed esophageal perforation is a significant postoperative complication of ACDFs but can be effectively treated through instrumentation removal and primary closure. Careful observation of symptoms post-ACDF and immediate evaluation upon present symptoms is paramount to managing esophageal perforations.

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颈前路椎间盘切除术融合术后迟发性食管穿孔的一期修复。

研究设计：回顾性临床病例系列。目的：本研究的目的是分析一系列颈椎前路椎间盘切除术和融合（ACDF）后出现延迟性食管穿孔的患者，并描述其表现、原因和初级食管修复的疗效。背景资料总结：ACDF术后迟发性食管穿孔是一种罕见但重要的并发症。方法：回顾性分析1998年至2023年在同一耳鼻喉科就诊的18岁以上食管穿孔患者。7例患者符合纳入标准。如果患者有既往ACDF的延迟性食管穿孔，则纳入研究。收集人口统计学、合并症、住院时间、手术细节和术后检查结果。结果：平均年龄63.6±10.0岁，女性4例（57%）。从ACDF到食管穿孔修复的平均时间为2.25 （IQR: 7）年。患者表现为吞咽困难、发音困难、颈部脓肿、皮瘘和/或颈部疼痛。提出的食管穿孔的原因包括内镜下器械外露（N=2）、器械前移位（N=2）、器械错位（N=1）、器械失败和感染（N=1）、钢板粘附咽食管节段导致活动时穿孔（N=1）。所有患者均成功切除了内固定，随后进行了食管缺损的初步闭合。食管修复术后的平均随访时间为464.4±443.4天。先前ACDF的中位随访时间为4.25 （IQR: 6.75）年。结论：本研究表明，迟发性食管穿孔是ACDFs术后的重要并发症，但可通过器械移除和初级闭合有效治疗。仔细观察acdf后的症状并立即评估目前的症状对于治疗食管穿孔至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.