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Treatment considerations for cervical and cervicothoracic spondylodiscitis associated with esophageal fistula due to cancer history or accidental injury: a 9-patient case series

  • Original Article - Infection
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Abstract

Background

The combination of cervical spondylodiscitis and esophageal fistula is rare but life-threatening. Due to both the rarity of these conditions’ coincidence and the complexity and heterogeneity of individual cases, there is no optimal treatment or management approach. The aims of this study are to obtain an overview of patients’ outcomes and to discuss treatment options.

Method

This study is a retrospective analysis of patients who presented with cervical spondylodiscitis and associated esophageal fistula between January 2010 and November 2018. We examined reports of 59 patients who suffered from cervical spondylodiscitis and included nine patients (15.25%) who had an esophageal fistula as the underlying cause. We assessed clinical findings, treatment, and outcome.

Results

Three of the nine patients were female, and the mean age of the sample was 64.56 years. Six of the patients had a history of esophagopharyngeal cancer and had undergone tumor resection followed by radiotherapy. Two of the remaining patients’ fistulas were caused by an iatrogenic injury during cervical spine surgery and a swallowed toothpick; in the final case, the origin remained unclear. Five patients presented with tetraparesis or tetraplegia, and the other four patients were neurologically intact. In seven cases, dorsal instrumentation was initially performed. Three patients secondarily received a ventral approach for debridement, and one received explantation of the ventral implants. Two patients died during the hospital stay, and three were transferred to a palliative care unit. Thus, the spondylodiscitis and esophageal fistula were cured in only four patients. At discharge, two patients were neurologically intact, two others remained in tetraparesis.

Conclusions

Cervical spondylodiscitis in association with an esophageal fistula carries high morbidity and high mortality. Because patients whose infections are not cured have high morbidity, we recommend using interdisciplinary and individual management, including definite surgical treatment of the discitis and fistula, in every case.

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Abbreviations

ENT:

Ear, nose, and throat

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Author information

Author notes

  1. Insa Janssen and Ehab Shiban contributed equally to this work.

Authors and Affiliations

  1. Department of Neurochirurgie, Hôpitaux Universitaires Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland

    Insa Janssen

  2. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Insa Janssen, Ehab Shiban, Anna Rienmüller, Yu-Mi Ryang & Bernhard Meyer

  3. Department of Neurosurgery, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany

    Ehab Shiban

  4. Department of Orthopedics and Trauma surgery, University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Anna Rienmüller

  5. Department of Neurosurgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Yu-Mi Ryang

  6. Department of Ear, Nose and Throat Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Adam M. Chaker

Authors
  1. Insa Janssen
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Corresponding author

Correspondence to Insa Janssen.

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The authors declare that they have no conflict of interest.

Ethical approval

The Ethics Committee approved this study (No. 238/17S). For this type of study, formal consent is not required, because all patients signed forms consenting to allow the clinic to store and analyze their data, tissue and blood samples for scientific purposes.

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Janssen, I., Shiban, E., Rienmüller, A. et al. Treatment considerations for cervical and cervicothoracic spondylodiscitis associated with esophageal fistula due to cancer history or accidental injury: a 9-patient case series. Acta Neurochir 161, 1877–1886 (2019). https://doi.org/10.1007/s00701-019-03985-3

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  • DOI: https://doi.org/10.1007/s00701-019-03985-3

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