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Ivanauskas E, Jones KA. Not Your Typical Sore Throat-A Case Report on Delayed Complications From Cervical Spinal Surgery. Ann Emerg Med 2024; 83:68-71. [PMID: 37676180 DOI: 10.1016/j.annemergmed.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
Esophageal perforation is an uncommon illness with a mortality rate as high as 50%. It is most frequently caused by iatrogenic instrumentation for both diagnostic and therapeutic purposes. Noniatrogenic spontaneous ruptures account for 15% of cases, followed by traumatic injury and rupture secondary to a foreign body.1 Sore throat is a common emergency medicine complaint with an array of causes and severity of pathology. We report a case of a sore throat resulting from esophageal perforation and prevertebral abscess as delayed complications from an anterior cervical surgery.
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Affiliation(s)
- Emma Ivanauskas
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Kerin A Jones
- Department of Emergency Medicine, Wayne State University, Detroit, MI.
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2
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Chan Y, Cheuk KY, Lai KW, Mak KL, Lai TW. Esophageal perforation following cervical spinal surgery with instrumentation: A case report on primary repair with pedicled sternocleidomastoid muscle flap reinforcement and review of the literature. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Chan
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. Y. Cheuk
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. W. Lai
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. L. Mak
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - T. W. Lai
- Department of Surgery Princess Margaret Hospital Hong Kong
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Moletta L, Pierobon ES, Salvador R, Volpin F, Finocchiaro FM, Capovilla G, Piangerelli A, Ciccioli E, Zanchettin G, Costantini M, Merigliano S, Valmasoni M. Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature. Global Spine J 2022; 12:719-731. [PMID: 33887971 PMCID: PMC9109565 DOI: 10.1177/21925682211005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Case series and systematic review of the Literature. OBJECTIVES Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. METHODS Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. RESULTS Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. CONCLUSIONS PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.
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Affiliation(s)
- Lucia Moletta
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Renato Salvador
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy,Renato Salvador, Department of Surgical,
Oncological and Gastroenterological Sciences, University of Padova, Clinica
Chirurgica 3°, Via Giustiniani 2, 35128, Padova, Italy.
| | - Francesco Volpin
- Department of Neurosciences,
University Hospital of Padova, Unit of Neurosurgery, Via Giustiniani 2, Padova,
Italy
| | | | - Giovanni Capovilla
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Alfredo Piangerelli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Eleonora Ciccioli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Gianpietro Zanchettin
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
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Pharyngoesophageal Damage from Hardware Extrusion at an Average of 7.5 Years After Anterior Cervical Diskectomy and Fusion: A Case Series, Discussion of Risk Factors, and Guide for Management. World Neurosurg 2022; 160:e189-e198. [PMID: 34990840 DOI: 10.1016/j.wneu.2021.12.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We present a single-institution case series of patients who experienced pharyngoesophageal damage, specifically from extruded hardware occurring at an average of 7.5 years after anterior cervical diskectomy and fusion (ACDF). METHODS A retrospective chart review was conducted of patients who had undergone ACDF with subsequent delayed pharyngoesophageal perforation or erosion from extruded hardware ≥1 year after surgery. A discussion of the literature surrounding this complication, including risk factors and management, is also presented. RESULTS Nine patients were identified (average age 58 years, 66.7% male) among a total of 4122 ACDF patients (incidence: 0.22%). Average time to injury was 7.5 years. Indications for initial ACDF were degenerative cervical disease (n = 7), ankylosing spondylitis (n = 1), and cervical fracture (n = 1). Eight patients had prior multilevel ACDF spanning 2 (n = 4), 3 (n = 1), or 4 levels (n = 2). Fusion levels for prior ACDF included C5-C7 (n = 3), C3-C7 (n = 2), C4-C7 (n = 1), C4-C6 (n = 1), C2-C5 (n = 1), and C6-C7 (n = 1). Pharyngoesophageal injuries included esophageal perforation (n = 3), pharyngeal perforation (n = 2), esophageal erosion (n = 3), and pharyngoesophageal erosion (n = 1). In most (n = 6) cases, the cause of pharyngoesophageal damage was due to ≥1 extruded screws. Dysphagia (n = 8) was the most common presenting symptom. For perforations (n = 5), 2 repairs used a rotational flap to reinforce a primary closure; the other 3 cases were repaired via primary closure. CONCLUSIONS Pharyngoesophageal damage caused by extruded hardware may occur several years after ACDF. These delayed complications are difficult to predict. Proper screw placement may be the most important factor for minimizing the chances of this potentially devastating complication, particularly with multilevel constructs.
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Modi HN, Shreshtha U, Patel U, Kotecha H, Patel MD, Dileep P. Esophageal Perforation After Anterior Cervical Surgery: A Case Report and Literature Review. Clin Spine Surg 2022; 35:49-58. [PMID: 34232154 DOI: 10.1097/bsd.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
SUMMARY AND BACKGROUND Esophageal perforation (EP) after anterior cervical surgery is a rare but potentially life-threatening condition. EP caused by malpositioned implants in cervical spine injury with multiple comorbidities is challenging to treat simultaneously. STUDY This was a case report study. PURPOSE OF STUDY The aim of this study was to present successful treatment of EP in a subluxated C5-C6 level with implant failure, infection, septicemia, and comorbidities. The aim was to emphasize the need for a multispecialty approach while treating serious complications. CASE A 72-year-old woman presented to the ER with a history of operated cervical spine a week ago and having breathlessness, fever, wound infection, and tracheostomy in situ. After primary investigations, the patient was initially treated in the intensive care unit, where bleeding from the tracheostomy site was noticed. Upon endoscopy, EP was diagnosed due to implant failure. She was operated for revision cervical spine surgery (drainage of pus with anterior and posterior cervical fixation) and percutaneous endoscopic gastrostomy tube insertion (esophageal diversion). On exploration of EP, a decision was made to perform conservative treatment as initial tag sutures did not hold due to infection. Postoperatively, the patient developed rectal bleed 3 times, which was ultimately treated with cecal bleed embolization. The infected cervical wound was managed with an open dressing. The patient was managed with intermittent assisted ventilation through tracheostomy postoperatively. Barium swallow at 10 weeks confirmed healing of EP and oral feed was started. Tracheostomy closure was performed once the wound had healed, and the patient was discharged with improved neurology at 12 weeks. CONCLUSIONS Perioperative problems after cervical surgery such as breathing difficulty, wound discharge, and worsening of neurology may lead to suspicion of underlying EP due to implant failure. Upper gastrointestinal endoscopy needs to be considered for a prompt diagnosis. Revision spine surgery with treatment of perforation simultaneously and maintenance of enteral nutrition through a percutaneous endoscopic gastrostomy tube with a multispecialty approach is recommended for this potentially life-threatening condition.
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Affiliation(s)
- Hitesh N Modi
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | - Utsab Shreshtha
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | - Udit Patel
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited
| | | | | | - Pratibha Dileep
- Critical Care Medicine and Pulmonology, Zydus Hospital, Ahmedabad, Gujarat, India
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Azhdam AM, Borrelli M, Orosco RK. Contralateral Pectoralis Flap for Repair of Spinal Hardware-Associated Fistula. EAR, NOSE & THROAT JOURNAL 2021; 100:884S-887S. [PMID: 34550017 DOI: 10.1177/01455613211039043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of a recurrent hypopharyngeal fistula following spinal hardware placement that required multiple procedures. The course was complicated by a medication error and ultimately the fistula resolved after contralateral pectoralis muscle flap.
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Affiliation(s)
- Ariel M Azhdam
- Cedars-Sinai Sinus Center of Excellence, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Chicago Medical School, 97174Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Michela Borrelli
- Cedars-Sinai Sinus Center of Excellence, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ryan K Orosco
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 8784University of California, San Diego, CA, USA.,Moores Cancer Center, La Jolla, CA, USA
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Dahm J, Nwaudo D, Gooi Z, Lee M, El Dafrawy M. Migration of an Anterior Cervical Discectomy and Fusion Screw into the Constrictor Muscle of the Hypopharynx: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00078. [PMID: 34010178 DOI: 10.2106/jbjs.cc.20.00873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 53-year-old man developed dysphagia 4 years after anterior cervical discectomy and fusion (ACDF), and radiographs revealed a dislodged screw anterior to the ACDF plate. Intraoperatively, the screw was found to be completely embedded within the pharyngeal constrictor muscle fibers and was removed with assistance from otolaryngology without injury to the pharyngeal mucosa. CONCLUSION Implant migration after ACDF can variably damage tracheoesophageal and retropharyngeal structures, and a multidisciplinary approach involving otolaryngology or thoracic surgery may be required to diagnose and treat these complications.
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Affiliation(s)
- James Dahm
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Darlington Nwaudo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Zhen Gooi
- Department of Otolaryngology, University of Chicago Medical Center, Chicago, Illinois
| | - Michael Lee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Mostafa El Dafrawy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, Illinois
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Dantas FLR, Dantas F, Mendes PD, Sandes BL, Fonseca Filho G. Primary Repair of Esophageal Perforation Following Anterior Cervical Fusion. Cureus 2020; 12:e11590. [PMID: 33364112 PMCID: PMC7749799 DOI: 10.7759/cureus.11590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Anterior cervical fusion has been performed safely and effectively for decades for the treatment of multiple pathologies, with low rates of morbidity and mortality. Esophageal perforation is a rare but potentially serious complication of anterior cervical spine approaches. There is no consensus regarding the best treatment strategies for this complication. Objectives To determine the prevalence of esophageal perforation following anterior cervical fusion in a single institution and to describe two cases of this complication that were treated with primary repair. Methods We retrospectively analyzed all consecutive patients who underwent anterior cervical fusion in a single private institution from January 1999 to August 2017. Patients who developed esophageal perforation per- or postoperatively were included in the analysis. Results A total of 830 anterior cervical fusion surgeries were performed during the analyzed period. Two cases (0.24%), both of male patients, were complicated by esophageal perforation, one intraoperatively and the other four years after the first surgery. Both patients were treated with primary esophageal repair, and good outcomes were obtained. Conclusion Primary repair is a therapeutic option in cases of esophageal perforation after anterior cervical fusion. Satisfactory results were obtained in both cases. Further studies are necessary to elucidate the best therapeutic options for this rare complication.
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Affiliation(s)
| | - François Dantas
- Neurological Surgery, Biocor Instituto, Belo Horizonte, BRA.,Neurological Surgery, Hospital Vila da Serra, Belo Horizonte, BRA
| | | | - Bruno L Sandes
- Neurological Surgery, Biocor Instituto, Belo Horizonte, BRA
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