Pharyngo-oesophageal perforation following anterior cervical discectomy and fusion: management and results.
OBJECTIVE
Pharyngo-oesophageal perforation is a rare, life-threatening complication of anterior cervical discectomy and fusion surgery; its management remains poorly defined. We reviewed our experience to understand the treatment of this dreadful complication.


METHODS
Data regarding the demographics, clinical course, diagnosis, management and outcomes of 15 cases of pharyngo-oesophageal perforations in 14 patients were collected during the period from 2003 to 2016.


RESULTS
Pharyngo-oesophageal perforation occurred at a median of 32 days (range 1 day-102 months) after anterior cervical discectomy and fusion surgery. Clinical manifestations included neck abscesses and cutaneous fistulas (10 cases), cervical swelling (two cases), salivary leakage from cervicotomy (two cases), dysphagia, halitosis and regurgitation (one case). In all cases, conservative management was utilized. Two patients affected by minor external fistulas were successfully managed conservatively. In 13 cases, the following surgery was performed: (i) radical bone debridement, total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement in one case each; (ii) anatomical suture of the fistula; or (iii) suture line reinforcement with myoplasty (in 11/13 cases). Perforation recurred in three cases. One patient underwent reoperation. The other two patients were treated conservatively At a median follow-up of 82 months (range 1-157 months), all patients exhibited permanent resolution of the perforation.


CONCLUSIONS
Patients with minimal leaks in the absence of systemic infection can be managed conservatively. For cases of large fistulas with systemic infection, we recommend partial or total removal of the fixation devices, direct suture of the oesophageal defect and coverage with tissue flaps.
Division of Thoracic Surgery Maria Cecilia Hospital-GVM Care and Research, Lugo, Italy and Alma Mater Studiorum, University of Bologna, Bologna, Italy.|Course of Doctorate in Cardio-Nephro-Thoracic Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Ottorino
O
Perrone
Course of Doctorate in Cardio-Nephro-Thoracic Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Valentina
V
Tassi
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Benedetta
B
Mattioli
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Niccolò
N
Daddi
Intensive Care Unit, Montecatone Rehabilitation Hospital, Imola, Italy.
Mariella
M
Uneddu
Division of Neurosurgery, Maria Cecilia Hospital-GVM Care and Research, Lugo, Italy.
Ignazio
I
Borghesi
Division of Thoracic Surgery Maria Cecilia Hospital-GVM Care and Research, Lugo, Italy and Alma Mater Studiorum, University of Bologna, Bologna, Italy sandro.mattioli@unibo.it.|Course of Doctorate in Cardio-Nephro-Thoracic Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Sandro
S
Mattioli
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult
Anterior cervical discectomy and fusion; Mediastinitis; Muscular flap; Pharyngo-oesophageal perforation; Spine stabilization; Surgery