title: Management of cervical esophageal injury after spinal surgery.
abstract: 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.
authors.affiliation: Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rueth
authors.forename: Darcy
authors.initials: D
authors.lastname: Shaw
authors.forename: Shawn
authors.initials: S
authors.lastname: Groth
authors.forename: Sarah
authors.initials: S
authors.lastname: Stranberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sembrano
authors.forename: Michael
authors.initials: M
authors.lastname: Maddaus
authors.forename: Rafael
authors.initials: R
authors.lastname: Andrade
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents