title: Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.
abstract: OBJECTIVE
  To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery.
  
  
  METHODS
  Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively.
  
  
  RESULTS
  During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal.
  
  
  CONCLUSIONS
  Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury.
authors.affiliation: Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea.
authors.forename: Moo Sung
authors.initials: MS
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Kuh
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Chin
authors.affiliation: Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Jin
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: spinekks@yuhs.ac.
authors.forename: Keun Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019468:Disease Management; D004939:Esophageal Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010614:Pharynx / Q000000981:diagnostic imaging / Q000293:injuries*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Cervical spine; Complications; Esophageal perforation; Revision; Spine surgery