Anterior Cervical Discectomy and Fusion Is Not a Benign Procedure

Abstract

Objective: 1) Present 5 cases of esophageal injury following anterior cervical discectomy and fusion. 2) Discuss the existing literature on mechanism of injury, presentation, and treatment. Method: This study is a retrospective case series conducted between 2009 and 2011, reviewing the presentation, and treatment of 5 cases of esophageal injury following anterior cervical discectomy and fusion. Results: All 5 patients in the series presented with dysphagia. The esophageal injuries in 3 out of 5 cases were identified on barium swallow. In 2 of the 5 patients esophageal injury was not identified until direct laryngoscopy was performed. Four out of 5 of the patients presented in the case series were repaired with sternocleidomastoid flaps and one with endoscopic diverticulotomy alone. All patients had improvement in their symptoms and 3 of the 5 patients completely recovered esophageal function. Conclusion: With the increased number of anterior cervical disk fusion cases being performed, there are more complications that otolaryngologists must be aware of. Esophageal perforation is a very serious complication and early recognition and treatment are necessary to prevent serious morbidity and mortality. As imaging does not easily identify esophageal perforation, endoscopy is recommended to optimize identification. Management of perforation is best conducted with sternocledoimastoid flaps, which are ideal for esophageal reinforcement because of their excellent blood supply and low donor site morbidity.