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European Spine Journal

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01-07-2016 | Review Article

Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm

Authors: Ferhat Harman, Erkan Kaptanoglu, Askin Esen Hasturk

Published in: European Spine Journal | Issue 7/2016

Abstract

Purpose

To review relevant data for the management of esophageal perforation after anterior cervical surgery.

Methods

A case of delayed esophageal perforation after anterior cervical surgery has been presented and the relevant literature between 1958 and 2014 was reviewed. A total of 57 papers regarding esophageal perforation following anterior cervical surgery were found and utilized in this review.

Results

The treatment options for esophageal perforation after anterior cervical surgery were discussed and a novel management algorithm was proposed.

Conclusion

Following anterior cervical surgery, patients should be closely followed up in the postoperative period for risk of esophageal perforation. Development of symptoms like dysphagia, pneumonia, fever, odynophagia, hoarseness, weight loss, and breathing difficulty in patients with a history of previous anterior cervical surgery should alert us for a possible esophageal injury. Review of the literature revealed that conservative treatment is advocated for early and small esophageal perforations. Surgical treatment may be considered for large esophageal defects.

Cloward R (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–614CrossRefPubMed

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(3):607–624PubMed

Fogel GR, McDonnell MF (2005) Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J 5:140–144CrossRefPubMed

Sahjpaul RL (2007) Esophageal perforation from anterior cervical screw migration. Surg Neurol 68:205–209CrossRefPubMed

Solerio D, Ruffini E, Gargiulo G, Camandona M, Raggio E, Solini A, Dei Poli M (2008) Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating. Eur Spine J 17(Suppl 2):280–284CrossRefPubMedCentral

Nérot C, Jeanneret B, Lardenois T, Lépousé C (2002) Esophageal perforation after fracture of the cervical spine: case report and review of the literature. J Spinal Disord Tech 15:513–518CrossRefPubMed

Pichler W, Maier A, Rappl T, Clement HG, Grechenig W (2006) Delayed hypopharingeal and esophageal perforation after anterior spinal fusion. Spine 31:E268–E270CrossRefPubMed

Ardon H, Van Calenbergh F, Van Raemdonck D, Nafteux P, Depreitere B, van Loon J, Goffin J (2009) Oesophageal perforation after anterior cervical surgery: management in four patients. Acta Neurochir (Wien) 151:297–302CrossRef

Vrouenraets BC, Been HD, Brouwer-Mladin R, Bruno M, van Lanschot JJ (2004) Esophageal perforation associated with cervical spine surgery: report of two cases and review of the literature. Dig Surg 21:246–249CrossRefPubMed

10.

von Rahden BH, Stein HJ, Scherer MA (2005) Late hypopharyngo-esophageal perforation after cervical spine surgery: proposal of a therapeutic strategy. Eur Spine J 14:880–886CrossRef

11.

Kim SJ, Ju CI, Kim DM, Kim SW (2013) Delayed esophageal perforation after cervical spine plating. Korean J Spine 10:174–176CrossRefPubMedPubMedCentral

12.

Bellaiche S, Di Blasio R, Luauté J, Jacquin-Courtois S, Boisson D, Charvier K, Tell L, Rode G (2013) Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med 56:41–50CrossRefPubMed

13.

Benazzo M, Spasiano R, Bertino G, Occhini A, Gatti P (2008) Sternocleidomastoid muscle flap in esophageal perforation repair after cervical spine surgery: concepts, techniques, and personal experience. J Spinal Disord Tech 21:597–605CrossRefPubMed

14.

Kelly MF, Spiegel J, Rizzo KA, Zwillenberg D (1991) Delayed pharyngoesophageal perforation: a complication of anterior spine surgery. Ann Otol Rhinol Laryngol 100:201–205CrossRefPubMed

15.

Whitehill R, Sirna EC, Young DC, Cantrell RW (1985) Late esophageal perforation from an autogenous bone graft. Report of a case. J Bone Joint Surg Am 67:644–645PubMed

16.

Cagli S, Isik HS, Zileli M (2009) Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg 19:437–440PubMed

17.

Amhaz HH, Kuo R, Vaidya R, Orlewicz MS (2013) Esophageal perforation following cervical spine surgery: a review with considerations in airway management. Int J Crit Illn Inj Sci 3:276–278CrossRefPubMedPubMedCentral

18.

Fountas KN, Kapsalaki EZ, Machinis T, Robinson JS (2006) Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating. J Spinal Disord Tech 19:199–203CrossRefPubMed

19.

Dakwar E, Uribe JS, Padhya TA, Vale FL (2009) Management of delayed esophageal perforations after anterior cervical spinal surgery. J Neurosurg Spine 11:320–325CrossRefPubMed

20.

Haku T, Okuda S, Kanematsu F, Oda T, Miyauchi A, Yamamoto T, Iwasaki M (2008) Repair of cervical esophageal perforation using longus colli muscle flap: a case report of a patient with cervical spinal cord injury. Spine J 8:831–835CrossRefPubMed

21.

Reid RR, Dutra J, Conley DB, Ondra SL, Dumanian GA (2004) Improved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap. Report of four cases. J Neurosurg (1 Suppl Spine) 100:66–70CrossRef

22.

Hanci M, Toprak M, Sarioğlu AC, Kaynar MY, Uzan M, Işlak C (1995) Oesophageal perforation subsequent to anterior cervical spine screw/plate fixation. Paraplegia 33:606–609CrossRefPubMed

23.

Phommachanh V, Patil YJ, McCaffrey TV, Vale F, Freeman TB, Padhya TA (2010) Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery. Laryngoscope 120:930–936PubMed

24.

Zairi F, Tetard MC, Thines L, Assaker R (2012) Management of delayed oesophagus perforation and osteomyelitis after cervical spine surgery: review of the literature. Br J Neurosurg 26:185–188CrossRefPubMed

25.

Gazzeri R, Tamorri M, Faiola A, Gazzeri G (2008) Delayed migration of a screw into the gastrointestinal tract after anterior cervical spine plating. Spine 33:E268–E271CrossRefPubMed

26.

Korovessis P, Repantis T, Vitsas V, Vardakastanis K (2013) Cervical spondylodiscitis associated with oesophageal perforation: a rare complication after anterior cervical fusion. Eur J Orthop Surg Traumatol 23(Suppl 2):159–163CrossRef

27.

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 18:1374–1380CrossRefPubMed

28.

Almre I, Asser A, Laisaar T (2014) Pharyngoesophageal diverticulum perforation 18 years after anterior cervical fixation. Interact Cardiovasc Thorac Surg 18:240–241CrossRefPubMed

29.

Bonavina L et al (2009) Re: esophageal injury associated with anteriorcervical spine surgery (Patel et al. Surg Neurol 2008;69:20–24). Surg Neurol 71:727–728CrossRefPubMed

30.

Lu DC, Theodore P, Korn WM, Chou D (2008) Esophageal erosion 9 years after anterior cervical plate implantation. Surg Neurol 69:310–312CrossRefPubMed

31.

Finiels PJ, Hernandez G, Sabatier P, Frerebeau P (2000) Delayed esophageal perforation after cervical osteosynthesis. Case illustration. J Neurosurg 92(1 Suppl):123PubMed

32.

Küntscher MV, Erdmann D, Boltze WH, Germann G (2003) Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature. Spinal Cord 41:543–548CrossRefPubMed

33.

Lucas J, Smith E, Eskander M, McPhee J, Lapinsky A (2013) Esophageal perforation more than 10 years after anterior cervical spine plating. Clin Neurol Neurosurg 115:1842–1844CrossRefPubMed

34.

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 30:E617–E622CrossRefPubMed

35.

Nourbakhsh A, Garges KJ (2007) Esophageal perforation with a locking screw: a case report and review of the literature. Spine 32:E428–E435CrossRefPubMed

36.

Orlando ER, Caroli E, Ferrante L (2003) Management of the cervical esophagus and hypofarinx perforations complicating anterior cervical spine surgery. Spine 28:E290–E295PubMed

37.

Patel NP, Wolcott WP, Johnson JP, Cambron H, Lewin M, McBride D, Batzdorf U (2008) Esophageal injury associated with anterior cervical spine surgery. Surg Neurol 69:20–24CrossRefPubMed

38.

Shenoy SN, Raja A (2003) Delayed pharyngo-esophageal perforation: rare complication of anterior cervical spine surgery. Neurol India 51:534–536PubMed

39.

Smith MD, Bolesta MJ (1992) Esophageal perforation after anterior cervical plate fixation: a report of two cases. J Spinal Disord 5:357–362CrossRefPubMed

40.

Sun L, Song YM, Liu LM, Gong Q, Liu H, Li T, Kong QQ, Zeng JC (2012) Causes, treatment and prevention of esophageal fistulas in anterior cervical spine surgery. Orthop Surg 4:241–246CrossRefPubMed

41.

Witwer BP, Resnick DK (2003) Delayed esophageal injury without instrumentation failure: complication of anterior cervical instrumentation. J Spinal Disord Tech 16:519–523CrossRefPubMed

42.

Zdichavsky M, Blauth M, Bosch U, Rosenthal H, Knop C, Bastian L (2004) Late esophageal perforation complicating anterior cervical plate fixation in ankylosing spondylitis: a case report and review of the literature. Arch Orthop Trauma Surg 124:349–353CrossRefPubMed

43.

Kim YJ, Glazer PA (2002) Delayed esophageal perforation and abscess formation after cervical vertebrectomy and fusion. Orthopedics 25:1091–1093PubMed

44.

Guarner-Argente C, Chandrasekhara V, Levine MS, Marcotte PJ, Weinstein GS, Ginsberg GG (2011) Esophageal stent-induced fistulization to an anterior cervical plate. Gastrointest Endosc 74:219–221CrossRefPubMed

45.

De Moor V, De Witte O, Zalcman M, Gelin M, Le Moine O, El Nakadi I (2005) Oesophageal perforation by an anterior cervical fixation device: management in debilitated patients. Acta Gastroenterol Belg 68:267–269PubMed

46.

Kau RL, Kim N, Hinni ML, Patel NP (2010) Repair of esophageal perforation due to anterior cervical spine instrumentation. Laryngoscope 120:739–742CrossRefPubMed

47.

Wierzbicka M, Bartochowska A, Banaszewski J, Szyfter W (2013) Cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery salvaged with regional and free flaps. Neurol Neurochir Pol 47:43–48PubMed

48.

Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW (2000) Esophageal perforations after anterior cervical surgery. J Spinal Disord 13:77–84CrossRefPubMed

49.

Rueth N, Shaw D, Groth S, Stranberg S, D’Cunha J, Sembrano J, Maddaus M, Andrade R (2010) Management of cervical esophageal injury after spinal surgery. Ann Thorac Surg 90:1128–1133CrossRefPubMed

50.

Li Y, Zhu QS, Liu JC, Wu YT (2015) Acute cervical epidural hematoma, screw pullout, and esophageal perforation after anterior cervical corpectomy surgery: report of a case. Int Surg 100:334–340CrossRefPubMedPubMedCentral

51.

Zhong ZM, Jiang JM, Qu DB, Wang J, Li XP, Lu KW, Xu B, Chen JT (2013) Esophageal perforation related to anterior cervical spinal surgery. J Clin Neurosci 20:1402–1405CrossRefPubMed

52.

von der Hoeh NH, Voelker A, Jarvers JS, Gulow J, Heyde CE (2015) Results after the surgical treatment of anterior cervical hyperostosis causing dysphagia. Eur Spine J Suppl 4:489–493CrossRef

53.

Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC (2004) Evolving options in the management of esophageal perforation. Ann Thorac Surg 77:1475–1483CrossRefPubMed

54.

Giménez A, Franquet T, Erasmus JJ, Martínez S, Estrada P (2002) Thoracic complications of esophageal disorders. Radiographics 22:S247–S258CrossRefPubMed

55.

Wu JT, Mattox KL, Wall MJ Jr (2007) Esophageal perforations: new perspectives and treatment paradigms. J Trauma 63:1173–1184CrossRefPubMed

56.

Fuji T, Kuratsu S, Shirasaki N, Harada T, Tatsumi Y, Satani M et al (1991) Oesophagocutaneous fistula after anterior cervical spine surgery and successful treatment using a sternocleidomastoid muscle flap. A case report. Clin Orthop 267:8–13PubMed

57.

Sepesi B, Raymond DP, Peters JH (2010) Esophageal perforation: surgical, endoscopic and medical management strategies. Curr Opin Gastroenterol 26:379–383CrossRefPubMed

58.

Altorjay A, Kiss J, Vörös A, Bohák A (1997) Nonoperative management of esophageal perforations. Is it justified? Ann Surg 225:415–421CrossRefPubMedPubMedCentral

59.

Pompili A, Canitano S, Caroli F, Caterino M, Crecco M, Raus L, Occhipinti E (2002) Asymptomatic esophageal perforation caused by late screw migration after anterior cervical plating. Spine 27:E499–E502CrossRefPubMed

60.

Geyer TE, Foy MA (2001) Oral extrusion of a screw after anterior cervical spine plating. Spine 26:1814–1816CrossRefPubMed

61.

Hinojar AG, Díaz Díaz MA, Pun YW, Hinojar AA (2003) Management of hypopharyngeal and cervical oesophageal perforations. Auris Nasus Larynx 30:175–182CrossRefPubMed

62.

English GM, Hsu SF, Edgar R, Gibson-Eccles M (1992) Oesophageal trauma in patients with spinal cord injury. Paraplegia 30:903–912CrossRefPubMed

63.

Lu X, Guo Q, Ni B (2012) Esophagus perforation complicating anterior cervical spine surgery. Eur Spine J 21:172–177CrossRefPubMed

Title: Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm
Authors: Ferhat Harman
Erkan Kaptanoglu
Askin Esen Hasturk
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 7/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4394-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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