Esophageal perforation related to anterior cervical spinal surgery

Esophageal perforation is an uncommon but potentially fatal complication of anterior cervical spinal surgery. This study aimed to investigate the diagnosis and treatment of cervical esophageal perforation related to spinal surgery. Among 1097 consecutive cases of anterior cervical spinal surgery that were managed at our institution over a 20 year period, five patients with esophageal perforation were identified. We performed a retrospective review of the diagnoses and treatment of esophageal perforation in these five patients as well as another patient who was transferred from another hospital. The esophageal perforations in all six patients were recognized during the early postoperative period. All patients presented with neck pain, dysphagia, odynophagia, coughing, fever and incision swelling and drainage. Diagnosis was confirmed by one or several of the following methods: contrast swallow study; endoscopy; cervical radiographs; or oral methylene blue. Nasogastric tube, intravenous antibiotics, enteral and parenteral nutrition, and open drainage were conducted in all patients. The wound was debrided in three patients, while two had implant removal and primary suture of the perforation. Five patients had a good recovery with healing of the esophagus, while one patient died due to severe pneumonia. The early diagnosis of esophageal perforation related to cervical spinal surgery relies on clinical suspicion and efficient investigation. The selection of appropriate treatment options, which include esophageal rest, antibiotic administration, nutrition support, wound debridement, open drainage, and surgical repair, largely depends on when the perforation is recognized. Early diagnosis and prompt management of this complication are likely to result in a good clinical outcome.