Clinical Analysis Of Cases Of Esophageal Perforation Associated With Anterior Cervical Spine Surgery

Objective:To evaluate the causes, clinical manifestation, diagnosis, treatment and prevention of esophageal perforation associated with anterior cervical spine surgery.Methods:Three cases of esophageal perforation associated with anterior cervical spine surgery between January 1,2000 and December 31,2010 who were transferred from other hospitals and treated in our hospital were studied; the contents include the general information, operations, internal fixation materials, postoperative procedures, clinical manifestations, diagnosis and treatments.Results:In case one, since the first day after the anterior cervical discectomy and fusion (ACDF), progressive pneumoderm occurred, with pus and food residues observed when the wound was opened. The methylene blue leaked from the wound if it is taken in orally. The diagnosis of esophageal perforation is constituted. Debridement and removal of the internal fixation were performed, but the esophageal defect could not be repaired, thus, the infection aggravated and the patient died from severe bilateral pulmonary infection and quadriplegia in one month postoperatively. In case two,4.5 months after the anterior cervical corpectomy and fusion (ACCF), disphagia and inflammation of the right neck happened, and contrast swallowing study showed the leakage of contrast agent. Then the diagnosis of esophageal perforation is made. Incision and drainage, repair of the esophageal perforation and removal of the internal fixation were performed, and after the operation a nasogastric tube, extraoral nutrition, and the use of intravenous antibiotics and neck collar is given. Finally the defect healed, and the patient could take in food normally in 3 weeks after the repair of the esophagus. In case three,4 months after the ACCF, inflammation of the right neck happened. The leakage of pus and food residues after incision and drainage and the positive finding of contrast swallowing study led to the diagnosis of esophageal perforation. At the beginning, conservative treatments was tried, the perforation remained, then debride-ment, repair of the defect, removal of the internal fixation and reconstruction with part of right sternocleidomastoid were carried out.1 month after the repair, the patient could take in food normally. However,1.5 months after the repair, esophageal perforation reoccurred, even though debridement and repair of the esophagus were performed again. Recently, the patient still receives treatment.Conclusion:Esophageal perforation is an uncommon complication with serious consequences after anterior cervical spine surgery. Different types of the complication result from different causes and impact factors. The clinical presentation of patients with this condition can be variable, directly related to the width of the defect. Diagnosis is difficult to make, which requires combining clinical manifestations and test results, and suspicion for the esophageal perforation is critically important. Once the diagnosis is constituted, timely and proper treatment is needed. Different methods of treatment can be given based on different types. Doctors should carry out series of measures to prevent the complication.