Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion

Retrospective clinical case series.

The objective of our study was to analyze a series of patients with delayed esophageal perforations following anterior cervical discectomy and fusion (ACDF) and describe their presentation, causes, and the efficacy of primary esophageal repair.

Delayed esophageal perforation after ACDF is a rare but significant complication.

Patients above 18 years with esophageal perforations presenting to a single otolaryngologist from 1998 to 2023 were reviewed. Seven patients met inclusion criteria. Patients were included if they had a delayed esophageal perforation with a prior ACDF. Demographics, comorbidities, length of stay, operative details, and postoperative test results were collected.

The average age was 63.6±10.0 years, and 4 (57%) were female. The average time between ACDF and esophageal perforation repair was 2.25 (IQR: 7) years. Patients presented with symptoms of dysphagia, dysphonia, neck abscesses, cutaneous fistula, and/or neck pain. Proposed reasons for esophageal perforation included exposed instrumentation on endoscopy (N=2), anterior displacement of instrumentation (N=2), instrumentation malposition (N=1), failure and infection of instrumentation (N=1), and adherence of plate to pharyngoesophageal segments causing perforation upon mobilization (N=1). All patients were successfully treated with instrumentation removal followed by primary closure of the esophageal defect. The average length of follow-up from esophageal repair surgery was 464.4±443.4 days. The median length of follow-up from prior ACDF was 4.25 (IQR: 6.75) years.

This study demonstrates that delayed esophageal perforation is a significant postoperative complication of ACDFs but can be effectively treated through instrumentation removal and primary closure. Careful observation of symptoms post-ACDF and immediate evaluation upon present symptoms is paramount to managing esophageal perforations.