Allis Terah J, Grant Nazaneen N, Davidson Bruce J
Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA.
Ear Nose Throat J. 2010 Nov;89(11):E4-9. doi: 10.1177/014556131008901102.
Pharyngoesophageal diverticulum is a rare complication following anterior cervical discectomy and fusion (ACDF). Dysphagia is a well-documented complication associated with ACDF. It may result postoperatively from a variety of etiologies, including hardware displacement, pharyngeal edema, or vocal fold paresis. One rare cause of persistent dysphagia is the formation of a hypopharyngeal diverticulum, reported in the literature in 9 previous cases. Such diverticula after ACDF surgery may have pathogenesis that is distinct from that of typical Zenker diverticula. We report 3 new cases of hypopharyngeal diverticula in patients who underwent revision ACDFs. Variables assessed included age, sex, level of fusion, ACDF-related complications, and diverticulum management. Two patients underwent successful open surgical diverticulectomy and cricopharyngeal myotomy. In the third case, the patient had a small diverticulum close to the surgical hardware and minimal symptoms and was managed conservatively. Our cases, combined with the 9 previous cases, demonstrate commonalities, particularly with regard to the risk of revision spinal surgery and infection and subsequent hypopharyngeal diverticula development. Hypopharyngeal diverticulum can occur as a complication of ACDF and should be considered in patients with persistent dysphagia after surgery. In this patient population, open resection and cricopharyngeal myotomy are recommended.
咽食管憩室是颈椎前路椎间盘切除融合术（ACDF）后一种罕见的并发症。吞咽困难是ACDF相关的一种有充分文献记载的并发症。它可能在术后由多种病因引起，包括内固定移位、咽部水肿或声带麻痹。持续性吞咽困难的一个罕见原因是下咽憩室的形成，文献中此前已报道过9例。ACDF手术后的此类憩室可能具有与典型Zenker憩室不同的发病机制。我们报告了3例接受ACDF翻修手术患者发生下咽憩室的新病例。评估的变量包括年龄、性别、融合节段、ACDF相关并发症以及憩室的处理方式。2例患者成功接受了开放性手术憩室切除术和环咽肌切开术。在第3例中，患者有一个靠近手术内固定的小憩室且症状轻微，采取了保守治疗。我们的病例与此前的9例病例相结合，显示出一些共性，特别是在翻修脊柱手术和感染风险以及随后下咽憩室形成方面。下咽憩室可作为ACDF的并发症出现，对于术后持续性吞咽困难的患者应予以考虑。在这类患者中，建议进行开放性切除和环咽肌切开术。
