Esophageal Injuries in Anterior Cervical Surgery

Abstract

Background: Operative treatment of the cervical spine is commonly performed through an anterior Smith-Robinson approach. Injury to the esophagus during this approach is an uncommon though devastating injury that can be very difficult to diagnose. The discussion of esophageal injuries has been presented in individual case report format, and a thorough review of the literature has yet to be performed. Objective: To describe the clinical presentation, treatment, and outcomes for esophageal injuries associated with anterior cervical surgery. Method: A review of the medical literature associated with esophageal perforations and cervical spine surgery was performed using PubMed and the Ovid database from our institution. Results: The incidence of esophageal injuries in the setting of cervical spine surgery remains unknown. Potential risk factors include revision spine surgery, difficult surgical exposures, surgery for spine trauma, and a prior history of esophageal disease or surgery. The diagnosis of esophageal injury remains difficult; patient symptoms are nonspecific, and, although the detection rate is improving, diagnostic imaging is limited. Potential complications of injury include esophageal dysfunction, pharyngeal dysfunction, infection, and death. A delay in diagnosis may worsen patient outcomes, including mortality rates. Early treatment consisting of parenteral antibiotics, surgical debridement, drainage, and repair can greatly improve outcomes and decrease mortality. Conclusion: Esophageal injury associated with anterior cervical spine surgery is a potentially life-threatening complication. Detection of injuries is difficult even with advanced diagnostic imaging. Early detection and treatment may reduce the complications associated with injury, including patient death.