Esophageal perforation from anterior cervical screw migration.

Surg Neurol

Division of Neurosurgery, University of British Columbia, North Vancouver, British Columbia, Canada V7L 2L3.

Published: August 2007

Background: Esophageal perforation from anterior cervical instrumentation migration is an uncommon but potentially highly morbid or even fatal complication. Early recognition and aggressive investigation and treatment are essential to ensure good outcome.

Case Description: A 58-year-old man underwent C6 vertebrectomy and C5-7 interbody fusion with a cage and anterior cervical plate. After surgery he developed fever and recurrence of his symptoms and deficits, but was managed expectantly. He was then referred to the author's institution. A barium swallow demonstrated an esophageal fistula (a Gastrograffin swallow was falsely negative) caused by a migrated screw; serial radiographs confirmed its passage through the gastrointestinal tract. Revision surgery was required to repair the perforation and reconstruct the cervicothoracic spine. Intraoperative esophageal injection of methylene blue was helpful in demonstrating the site of leakage. Despite a prolonged postoperative course complicated by pulmonary embolus, the patient recovered with minimal residual deficit, and continues to do well 2 years later.

Conclusions: A high index of suspicion followed by aggressive investigation are crucial in the setting of unexpected neck pain, new neurologic deficit, fever, or swallowing difficulties in the early postoperative period after anterior cervical spine instrumentation. If esophageal perforation is suspected, a barium swallow is recommended over Gastrograffin, which, although less irritating to the surrounding tissues, may be falsely negative. Intraoperative methylene blue injection into the esophageal lumen is useful in identifying the site of perforation.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surneu.2006.09.032DOI Listing

Publication Analysis

Top Keywords

anterior cervical
16
esophageal perforation
12
perforation anterior
8
aggressive investigation
8
barium swallow
8
falsely negative
8
methylene blue
8
esophageal
6
anterior
4
cervical
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!