Esophageal perforation following anterior cervical spine surgery

76-year-old male with history of C7 fracture, treated with anterior cervical arthrodesis. Two weeks after surgery the patient had persistent dysphagia. A CT of the neck was performed, showing that the posterior wall of the esophagus was penetrated by the screws of the arthrodesis, with their distal ends in the esophageal lumen. A small air-fluid collection in the lateral region of the hypopharynx was also observed. Surgery was performed, the arthrodesis material was removed and the esophageal perforation was repaired. The patient required a second surgery due to the presence of an esophageal-cutaneous fistula. The patient had a favorable evolution with closure of the fistula, no dysphagia and returned to normal diet.

Anterior cervical arthrodesis is the treatment of choice for unstable cervical fractures. 12% of patients undergoing this type of surgery have dysphagia, usually mild and transient due to edema secondary to esophageal manipulation (1). Esophageal perforation is a rare but serious complication, with an incidence of less than 1%. It usually presents intra-surgically or in the early postoperative period, secondary to manipulation or by bone splinters that lacerate the esophageal walls. Less frequently it has a late presentation secondary to rupture or displacement of the surgical material, which generates erosion / necrosis of the esophageal walls. This complication should be suspected in patients with history of anterior cervical arthrodesis and persistent dysphagia, collections, cervical fistulas, or mediastinitis.

Cervical surgery with anterior approach is a procedure that is frequently performed for the treatment of cervical spine pathologies, in general it has good clinical results and associates little morbidity and mortality. A rare complication is esophageal perforation, but early diagnosis is important for timely treatment and thus avoid complications such as sepsis, mediastinitis or involvement of large vessels (2,3).

- Baron EM, Soliman AM, Gaughan JP, et al. Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical discectomy and fusion. Ann Otol Rhinol Laryngol 2003, 112:921–6. - Harman F, Kaptanoglu E, Hasturk AE. Esophag