Esophageal Injury Following Anterior Cervical Discectomy and Fusion: A Single-institution Retrospective Study

Esophageal perforation is a known but rare complication of anterior cervical discectomy and fusion (ACDF). Due to its rarity, factors associated with esophageal perforation have not been conclusively identified.

A retrospective study of patients who underwent ACDF at a tertiary care center between September 2016 and September 2021. Patients were identified using CPT codes 22551, 22552, 22554, and 22558. All subaxial cervical interbody fusions utilizing an anterior approach, including both discectomies and corpectomies, were included. Odontoid screws, cervical arthroplasty, and posterior-only fusions were excluded. Patients who were determined to have esophageal perforation were identified based on head and neck surgeon involvement in their hospital admission and ICD-10 code K22.3.

A total of 1454 patients met our inclusion criteria, among whom 13 patients were determined to have had a confirmed esophageal perforation (0.89%). There was a statistically significant association between multilevel ACDF and surgery for suspected esophageal perforation (p = 0.04655). There were no statistically significant associations between surgery for suspected esophageal perforation and age, female sex, active smoking status, diabetes, coronary artery disease, chronic obstructive pulmonary disease, or gastroesophageal reflux disease. Perforation occurred because of intraoperative injury in 4 patients and 3 patients underwent initial ACDF for an indication of trauma.

This study suggests that there may be an association between multilevel ACDF and esophageal perforation. Further larger studies will be needed to confirm this along with other risk factors for esophageal perforation.