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Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.

Authors
 Moo Sung Kang  ;  Kyung Hyun Kim  ;  Jeong Yoon Park  ;  Sung Uk Kuh  ;  Dong Kyu Chin  ;  Byung Ho Jin  ;  Keun Su Kim  ;  Yong Eun Cho 
Citation
 World Neurosurgery, Vol.102 : 275-283, 2017 
Journal Title
 World Neurosurgery 
ISSN
 1878-8750 
Issue Date
2017
MeSH
Adult ; Aged ; Cervical Vertebrae/surgery* ; Disease Management* ; Esophageal Perforation/diagnostic imaging ; Esophageal Perforation/etiology ; Esophageal Perforation/therapy* ; Esophagoscopy ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects* ; Pharynx/diagnostic imaging ; Pharynx/injuries* ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/therapy* ; Retrospective Studies ; Tomography Scanners, X-Ray Computed ; Young Adult
Keywords
Cervical spine ; Complications ; Esophageal perforation ; Revision ; Spine surgery
Abstract
OBJECTIVE: To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. METHODS: Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively. RESULTS: During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal. CONCLUSIONS: Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury.
Full Text
https://www.sciencedirect.com/science/article/pii/S1878875017303042
DOI
10.1016/j.wneu.2017.02.130
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
구성욱(Kuh, Sung Uk) ORCID logo https://orcid.org/0000-0003-2566-3209
김경현(Kim, Kyung Hyun)
김근수(Kim, Keun Su) ORCID logo https://orcid.org/0000-0002-3384-5638
박정윤(Park, Jeong Yoon) ORCID logo https://orcid.org/0000-0002-3728-7784
조용은(Cho, Yong Eun) ORCID logo https://orcid.org/0000-0001-9815-2720
진동규(Chin, Dong Kyu) ORCID logo https://orcid.org/0000-0002-9835-9294
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160631
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