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
{"title":"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。","authors":"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","doi":"10.1097/BSD.0000000000001927","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical case series.</p><p><strong>Objective: </strong>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.</p><p><strong>Summary of background data: </strong>Delayed esophageal perforation after ACDF is a rare but significant complication.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion.\",\"authors\":\"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\",\"doi\":\"10.1097/BSD.0000000000001927\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective clinical case series.</p><p><strong>Objective: </strong>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.</p><p><strong>Summary of background data: </strong>Delayed esophageal perforation after ACDF is a rare but significant complication.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001927\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001927","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion.
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.
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.
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