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Esophageal perforations after anterior cervical surgery
R F Gaudinez1, G M English, J S Gebhard
1Yale University Department of Orthopaedics and Rehabilitation, Center for Orthopaedics, New Haven, Connecticut, USA.
Journal of Spinal Disorders
|March 10, 2000
Summary
Esophageal perforation is a rare complication of anterior cervical surgery, particularly after cervical fracture repair. Prompt recognition of symptoms and surgical repair are crucial for successful management and reducing high mortality rates.
Area of Science:
- Otolaryngology
- Neurosurgery
- Gastroenterology
Background:
- Esophageal perforation is an uncommon complication following anterior cervical surgery.
- This study presents the largest series to date of esophageal perforations at Craig Hospital, spanning 25 years.
Purpose of the Study:
- To analyze the causes, clinical presentation, diagnostic challenges, and management outcomes of esophageal perforations after anterior cervical surgery.
- To highlight the importance of prompt diagnosis and treatment in improving patient outcomes.
Main Methods:
- Retrospective review of 44 patients with esophageal perforations presenting to Craig Hospital over 25 years.
- Analysis of patient demographics, surgical history (especially related to cervical fractures and plate/screw fixation), clinical symptoms, physical findings, diagnostic imaging, and treatment outcomes.
Main Results:
- 34 perforations were related to operations for cervical fractures, with 28 involving plate and screw fixation.
- Common symptoms included neck/throat pain, odynophagia, dysphagia, hoarseness, and aspiration.
- Key findings included fever, neck tenderness, subcutaneous emphysema, tachycardia, and blood in nasogastric tubes; imaging confirmed injury in only 72.7% of cases. 22 patients developed cervical osteomyelitis or abscess.
- Nonoperative management had high mortality; 42 patients required surgical repair, with an average hospital stay of 253 days.
Conclusions:
- Successful management hinges on physician awareness of causes, prompt recognition of symptoms/findings, and immediate treatment.
- Surgical repair is generally required, and nonoperative approaches are associated with high mortality.
- Early intervention is critical for patients experiencing esophageal perforations post-anterior cervical surgery.