Management of esophageal and pharyngeal perforation as complications of anterior cervical spine surgery

Abstract Objective To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. Methods Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were retrospectively analyzed. Results During the study period, seven patients (six male and one female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in two patients and because of a degenerative cervical disorder in five. Early esophageal perforation was diagnosed in two patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in five. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas five patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient expired because of postoperative pneumonia and sepsis after implant removal. Conclusions Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury.