Abstract
Esophageal perforation is a catastrophic complication of anterior cervical discectomy and fusion (ACDF). While direct surgical repair has been reported as optimal for restoration of upper gut function, we present the case of a 58-year-old woman who achieved complete resolution when treated only with debridement and drainage. We find that a supportive approach, surgical management without direct repair, may play a vital role in select patient populations in order to avoid potentially long-term consequences or radical treatments, like esophageal diversion. Decisions regarding direct repair versus debridement and inspection only should be made on a case-by-case basis through a multidisciplinary approach.
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References
Marawar S, Girardi FP, Sama AA, Ma Y, Gaber-Baylis LK, Besculides MC, Memtsoudis SG (2010) National trends in anterior cervical fusion procedures. Spine (Phila Pa 1976) 35:1454–1459. https://doi.org/10.1097/BRS.0b013e3181bef3cb
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:607–624
Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–236 discussion 236-228
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr (2007) Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32:2310–2317. https://doi.org/10.1097/BRS.0b013e318154c57e
Tetreault L, Ibrahim A, Cote P, Singh A, Fehlings MG (2016) A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine 24:77–99. https://doi.org/10.3171/2015.3.SPINE14971
Halani SH, Baum GR, Riley JP, Pradilla G, Refai D, Rodts GE Jr, Ahmad FU (2016) Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine 25:285–291. https://doi.org/10.3171/2016.1.SPINE15898
Navarro R, Javahery R, Eismont F, Arnold DJ, Bhatia NN, Vanni S, Levi AD (2005) The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery. Spine (Phila Pa 1976) 30:E617–E622
Ahn SH, Lee SH, Kim ES, Eoh W (2011) Successful repair of esophageal perforation after anterior cervical fusion for cervical spine fracture. J Clin Neurosci 18:1374–1380. https://doi.org/10.1016/j.jocn.2011.02.031
Nanda A, Sharma M, Sonig A, Ambekar S, Bollam P (2014) Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon's experience of 1,576 patients. World Neurosurg 82:1380–1387. https://doi.org/10.1016/j.wneu.2013.09.022
Eroglu A, Can Kurkcuogu I, Karaoganogu N, Tekinbas C, Yimaz O, Basog M (2004) Esophageal perforation: the importance of early diagnosis and primary repair. Dis Esophagus 17:91–94. https://doi.org/10.1111/j.1442-2050.2004.00382.x
Hanwright PJ, Purnell CA, Dumanian GA (2015) Flap reconstruction for esophageal perforation complicating anterior cervical spinal fusion: an 18-year experience. Plast Reconstr Surg Glob Open 3:e400. https://doi.org/10.1097/GOX.0000000000000350
Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC (2004) Evolving options in the management of esophageal perforation. Ann Thorac Surg 77:1475–1483. https://doi.org/10.1016/j.athoracsur.2003.08.037
Vogel SB, Rout WR, Martin TD, Abbitt PL (2005) Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 241:1016–1021 discussion 1021-1013
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Dr. Michael Wang is a consultant for DePuy Spine, K2 M, JoiMax and Aesculap Spine. He holds a patent with DePuy Spine and stock in Innovative Surgical Devices.
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Shah, S.S., Burks, S.S., Nguyen, D.M. et al. Spontaneous healing of a shredded esophagus after ACDF without direct repair. Acta Neurochir 160, 413–417 (2018). https://doi.org/10.1007/s00701-017-3414-7
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DOI: https://doi.org/10.1007/s00701-017-3414-7