School of Medicine, University of Washington, Seattle, Washington, USA.
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
World Neurosurg. 2020 Nov;143:102-107. doi: 10.1016/j.wneu.2020.07.151. Epub 2020 Jul 27.
Esophageal perforation represents a rare but potentially life-threatening complication of an anterior cervical diskectomy and fusion (ACDF). Delayed presentations of esophageal perforation more than 10 years following surgery are exceedingly rare and difficult to diagnose. Here, we discuss the case of an 80-year-old man who presented to the emergency department with progressive dysphagia 15 years after his ACDF.
While prior outpatient workup was suggestive of a diverticulum, there was no evidence of esophageal perforation. Progressive symptoms and repeat imaging on admission were suggestive of retropharyngeal phlegmon. Operative esophagoscopy revealed that the spinal hardware had eroded through the posterior wall of the esophagus, creating a traction diverticulum. The hardware was removed, and the esophageal perforation was closed primarily and buttressed with vascularized tissue from a supraclavicular artery island fascial flap.
This case emphasizes the importance of considering an esophageal perforation in patients who present with dysphagia at any interval following an ACDF, even in the extremely delayed setting. Furthermore, this is the first report, to the best of our knowledge, using a supraclavicular artery island fascial flap to reconstruct an esophageal perforation following an ACDF, and we introduce a novel strategy for managing these complicated injuries.
食管穿孔是颈椎前路椎间盘切除融合术（ACDF）后一种罕见但潜在危及生命的并发症。手术后超过 10 年出现食管穿孔的延迟表现极其罕见且难以诊断。在这里，我们讨论了一名 80 岁男性的病例，他在 ACDF 后 15 年因进行性吞咽困难到急诊科就诊。
虽然先前的门诊检查提示憩室，但没有证据表明存在食管穿孔。入院时进行的症状加重和重复影像学检查提示咽后蜂窝织炎。手术食管镜检查显示脊柱硬件已侵蚀食管后壁，形成牵引憩室。移除了硬件，并通过锁骨上动脉岛筋膜瓣的血管化组织对食管穿孔进行了直接和支撑性修复。
该病例强调了在 ACDF 后任何时间出现吞咽困难的患者中都要考虑食管穿孔的重要性，即使在非常延迟的情况下也是如此。此外，据我们所知，这是首例使用锁骨上动脉岛筋膜瓣修复 ACDF 后食管穿孔的报告，我们提出了一种处理这些复杂损伤的新策略。
