Document Detail

Esophageal injury associated with anterior cervical spine surgery.
MedLine Citation:
PMID:  17976697     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Anterior cervical spinal surgery has been used to treat a variety of conditions including spondylosis, fracture, tumor, infection, trauma, and instability. Esophageal perforation, a rare and unusual complication of anterior cervical procedures, has been largely relegated to only incidental case reports with few large retrospective studies performed to determine true incidence, treatment, etiology, and outcome. METHODS: More than 3000 anterior cervical spine surgeries conducted over a 30-year period by 5 active practicing surgeons were reviewed. There were 3 cases of esophageal injury identified with subsequent critical evaluation to determine presentation, diagnosis, risk factors, management, and outcomes. In addition, incidence rates were calculated based on overall occurrence and antecedent risk factors. RESULTS: Two of the patients with esophageal injury had predisposing risk factors, including diverticula or cervical spine trauma. The third patient had no antecedent risk factors. Symptoms included axial spine pain, odynophagia, dysphagia, purulent spondylitis, and sepsis. Treatment consisted of one or more of the following: reoperation with exploration and repair, esophageal diversion, esophageal rest, antibiotic administration, and wound drainage. Functional outcomes were achieved in all cases with no deaths. CONCLUSIONS: Esophageal injury incidence based on overall occurrence in this study was 0.1%. Patients with no antecedent risk factors had an incidence of 0.03%. Our results compare favorably with those of the Cervical Spine Research Society survey from 1989, which predicted an incidence of 0.25% based on questionnaires filed by surgeons, representing 1 of only 2 reports that included more than 1000 patients.
Naresh P Patel; W Putnam Wolcott; J Patrick Johnson; Helen Cambron; Marcial Lewin; Duncan McBride; Ulrich Batzdorf
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-10-31
Journal Detail:
Title:  Surgical neurology     Volume:  69     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-06     Completed Date:  2008-02-27     Revised Date:  2009-06-12    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-4; discission 24     Citation Subset:  IM    
Department of Neurological Surgical, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
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MeSH Terms
Cervical Vertebrae*
Cohort Studies
Esophageal Perforation / diagnosis,  etiology*,  therapy*
Middle Aged
Orthopedic Procedures / adverse effects*
Retrospective Studies
Risk Factors
Spinal Diseases / surgery*
Treatment Outcome
Comment In:
Surg Neurol. 2009 Jun;71(6):727-8   [PMID:  18786703 ]

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