Delayed Esophageal Perforation 14 Years after Cervical Anterior Decompression and Fusion: A Case Report

We describe an exceptionally rare case of delayed esophageal perforation that developed 14 years after anterior decompression and fusion (ADF) of the cervical spine, ultimately necessitating complex revision surgery.

A 62-year-old man had undergone C5-C7 ADF and experienced favorable neurological recovery, although postoperative screw loosening was noted. Fourteen years later, he developed progressive numbness and muscle weakness. Endoscopic examination revealed an esophageal perforation adjacent to the anterior plate. Considering the coexistence of cervical myelopathy, the patient underwent C3-T2 posterior decompression and fusion, implant removal, anterior reconstruction with a fibular graft, esophageal fistula closure, pectoralis major myocutaneous flap coverage, and tracheostomy. Following rehabilitation, he was able to resume oral feeding and ambulate with a cane 8 months postoperatively.

Esophageal perforation occurring more than a decade after ADF is extremely uncommon. In this case, chronic implant loosening was likely responsible. Because such complications often require extensive reconstructive procedures, vigilant long-term follow-up is crucial even after satisfactory early recovery.