title: Causes, treatment and prevention of esophageal fistulas in anterior cervical spine surgery.
abstract: OBJECTIVE
  To evaluate the causes, treatment and prevention of esophageal fistulas after anterior cervical spine surgery.
  
  
  METHODS
  Between January 2004 and December 2011, 5 of 2348 patients who underwent anterior cervical surgery in our hospital developed esophageal fistulas (three male and two female patients, average age 34 years). Their diagnoses were cervical injuries (three), cervical spondylosis (one) and cervical tuberculosis (one). Their esophageal fistulas were treated by debridement and exploratory surgery, primary suturing of the perforation and/or sternocleidomastoid myoplasty. If conservative treatment failed or esophageal fistula recurred, plate removal was offered. Postoperative treatment included esophageal rest, enteral nutrition, wound drainage, and antibiotics. Methylene blue was used to evaluate results.
  
  
  RESULTS
  An esophageal fistula was discovered during anterior cervical surgery in one patient and primary suturing performed. In four patients, fistulas were diagnosed after anterior cervical decompression and fusion. In one of these, only debridement and exploratory surgery were required. In another, a perforation was sutured during debridement and exploratory surgery. In the third, internal fixation was removed because of failure of prolonged conservative treatment. In the fourth, the esophageal fistula recurred repeatedly; he required removal of the hardware and reinforcement with a sternocleidomastoid muscle flap. At 6-48 months follow-up, all patients were in good condition, symptom free, and without cervical instability or infectious spondylitis.
  
  
  CONCLUSIONS
  Successful management of esophageal fistula after anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps, surgical drainage, esophageal rest and nutritional support, and removal of hardware if necessary. Prevention consists of careful surgery and gentle tissue handling.
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China. sunlin_9999@163.com
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
authors.forename: Yue-ming
authors.initials: YM
authors.lastname: Song
authors.forename: Li-min
authors.initials: LM
authors.lastname: Liu
authors.forename: Quan
authors.initials: Q
authors.lastname: Gong
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Qing-quan
authors.initials: QQ
authors.lastname: Kong
authors.forename: Jian-cheng
authors.initials: JC
authors.lastname: Zeng
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D004937:Esophageal Fistula / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D014399:Tuberculosis, Spinal / Q000601:surgery*