Iatrogenic esophageal rupture due to anterior cervical spine surgery

Abstract

Anterior cervical corpectomy from C2–T1 is being used to decompress and reconstruct the cervical spine for a wide variety of degenerative disorders, trauma, neoplasms, and infectious disorders or as a salvage surgery for correcting kyphotic deformities and vertebral collapse. The technique minimally disrupts normal cervical muscles and is associated with a low risk of injuring surrounding structures such as esophagus. A case of an iatrogenic esophageal wall perforation subsequent to cervical corpectomy through an anterior approach along with a review of the literature and an algorithm of treatment are presented. A 52-year-old, emphysematous man underwent anterior cervical stabilization using plate and screw for vertebral collapse of the C5 vertebra followed by a huge cervicofacial subcutaneous emphysema on the 1 st postoperative day. A cervical and chest CT was performed and revealed a rupture of esophagus at the site of the plate. The rupture was also confirmed by an esophagogram. The patient was led directly to surgery. During the procedure, the implant was in place, but a large defect was found along the posterior wall of the cervical part of the esophagus. The patient underwent wide drainage of the prevertebral space, direct repair of the defect of the esophagus with separate sutures and formation of a pedicle flap with sternocleidomastoideus and infrahyoid muscles leaving the osteosynthetic plate in place. Postoperatively he developed respiratory insufficiency and stayed intubated for 10 days in the ICU under antibiotic treatment. After a hospitalization of 24 days he was discharged and in a follow up of 6 months there was no recurrence. In during can be potentially life threatening. Early of the injury followed by case morbidity and mortality.