Management of cervical esophageal injury after spinal surgery.
BACKGROUND
Esophageal injury is a rare but catastrophic complication of anterior cervical spine surgery. Cases of esophageal perforation may be discovered intraoperatively, or as late as 10 years after surgery. In the current study we aim to review the principles of care and provide an algorithm that can be employed for successful management of this complex problem.


METHODS
We performed a retrospective, Institutional Review Board-approved review of esophageal injuries resulting from anterior cervical spine surgery that were managed at our institution between January 1, 2007 and July 31, 2009. We collected demographic information, perioperative data, and final outcomes. Data were analyzed using descriptive statistics.


RESULTS
We identified 6 patients who met our criteria. All patients presented with esophageal leaks, neck abscesses, and osteomyelitis. Similarly, all had been treated prior to transfer, without resolution of their leak. After debridement, removal of hardware, long-term antibiotic therapy, maximization of nutrition, and supportive care, 80% of patients resumed oral intake (median time 66.5 days). Mortality was 16.7%.


CONCLUSIONS
Neck exploration with removal of hardware, debridement, and open neck wound management are the basic principles of care. Management is often prolonged and requires multiple procedures; however, with persistence, closure is possible in the majority of patients. Our report serves as a guide for the treatment of this devastating problem.
Rueth
Natasha
N
Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Shaw
Darcy
D
Groth
Shawn
S
Stranberg
Sarah
S
D'Cunha
Jonathan
J
Sembrano
Jonathan
J
Maddaus
Michael
M
Andrade
Rafael
R
D000038:Abscess / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000601:surgery*; D003646:Debridement; D020878:Device Removal; D004322:Drainage; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010019:Osteomyelitis / Q000209:etiology / Q000628:therapy; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D055815:Young Adult
D000900:Anti-Bacterial Agents