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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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Okano I, Omata J, Hoshino Y, Usui Y, Toyone T, Inagaki K. Chronic dysphagia caused by Laryngo-vertebral Synostosis after anterior fusion for cervical spine trauma: a case report. BMC Musculoskelet Disord 2020; 21:143. [PMID: 32131796 PMCID: PMC7057656 DOI: 10.1186/s12891-020-3152-5] [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] [Received: 12/17/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior cervical spine surgery is often associated with postoperative dysphagia, but chronic dysphagia caused by laryngo-vertebral synostosis is extremely rare. We report a case of chronic dysphagia caused by synostosis between the cricoid cartilage and cervical spine after anterior surgery for cervical spine trauma. CASE PRESENTATIONS We present a case of a 39-year-old man who had sustained complex spine trauma at C5-6 associated with complete spinal cord injury at the age of 22; the patient presented with a 5-year history of chronic dysphagia. Computed tomography demonstrated posterior shift of the esophagus as well as calcification of the cricoid cartilage and its fusion to the right anterior tubercle of the C5 vertebra. A barium swallow study demonstrated significant barium aspiration into the airway and no laryngeal elevation. The patient underwent resection of the bony bridge and omohyoid muscle flap insertion. His symptoms ameliorated after surgery. CONCLUSION Synostosis between the cricoid cartilage and cervical spine may occur associated with cervical spine trauma and causes chronic dysphagia. Resection of the fused part can improve dysphagia caused by this rare condition and omohyoid muscle flap might be a good option to prevent recurrence.
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Affiliation(s)
- Ichiro Okano
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. .,Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Joe Omata
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yushi Hoshino
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Yuki Usui
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Yuan H, Ding H, Hu L, Buser Z, Zhao H, Li X. Treatment for early postoperative esophageal fistula complicated with anterior cervical surgery. J Orthop Surg (Hong Kong) 2017; 25:2309499016684418. [PMID: 28117633 DOI: 10.1177/2309499016684418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECT To investigate the efficacy of debridement, open drainage, and early feeding to treat early esophageal fistula complicated with anterior cervical surgery. METHODS Retrospective analysis was conducted on data from 3154 patients who had undergone anterior cervical surgeries for cervical vertebra diseases between January 2006 and January 2013, in which eight patients had esophageal fistula with five males and three females. Four patients had cervical spinal injuries and four patients had cervical spondylosis. All of whom had postoperative esophageal fistulas and underwent debridement and drainage. The wounds were left open for natural drainage. No drainage devices were placed in surgical sites, and no gastric tubes were placed after surgeries. Such normal food as rice balls but not liquid or semiliquid diet was recommended. Local pressurization was conducted with fists during feeding to prevent food overflowing from orificium fistulae. RESULTS Healed esophageal fistulas were achieved in all of the patients after 1-2 weeks treatment. There weren't recurrent esophageal fistulas and delayed infection found during 2-5 years follow-up. Good swallowing functions and stable cervical vertebrae were achieved in all of the patients. The satisfactory therapeutic effects were achieved in patients with previous neck diseases. Frankel classifications were increased by 1-2 grades in patients with cervical spinal injuries. JOA scores were increased from 9.5 before surgery to 15.5 after surgery in patients with cervical vertebra diseases. CONCLUSIONS Early postoperative esophageal fistula complication after anterior cervical surgery can successfully be treated by debridement, drainage without gastric tube, and with early oral postoperative feeding but without fluids.
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Affiliation(s)
- Haifeng Yuan
- 1 Department of Spine Surgery, The General Hospital, Ningxia Medical University, Ningxia, China
| | - Huiqiang Ding
- 1 Department of Spine Surgery, The General Hospital, Ningxia Medical University, Ningxia, China
| | - Lihong Hu
- 1 Department of Spine Surgery, The General Hospital, Ningxia Medical University, Ningxia, China
| | - Zorica Buser
- 2 Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Haoning Zhao
- 1 Department of Spine Surgery, The General Hospital, Ningxia Medical University, Ningxia, China
| | - Xusheng Li
- 1 Department of Spine Surgery, The General Hospital, Ningxia Medical University, Ningxia, China
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