Esophageal Perforation in a Cervical Fracture Patient With Progressed Ankylosing Spondylitis

Wang, Jianxi; Shi, Liangyu; Chen, Huajiang; Yuan, Wen

doi:10.1097/brs.0000000000001885

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…[11,14–16,19] But, the patients with heart or respiratory failure cannot afford the long surgery duration, severe surgical injury and high blood loss, high risk of perioperative period complications, this combined anterior–posterior method is not suitable for them. [11,14–16,18–22] …”

Section: Discussionmentioning

confidence: 99%

“…[14,15] Due to the extensive osteoporosis in spine of AS patients, it is very challenging for the surgery to avoid the second injury of spinal cord and the severe complications no matter which surgical approach adopted. [11–16] Generally, cervical fracture appears to be unstable Chance fracture, often affecting anterior, middle, and posterior column (3-column) with high probability of dislocation, neurological impairment. The surgery by simple anterior approach only fixes anterior and middle column, which cannot resist the posterior column tension.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the instrumental complications, such as screw loosening, breaking and migration, occur very often after simple anterior surgery, possibly further resulting in esophagus leakage. [12,16,19] It was reported that the decompression and fixation by posterior approach alone is better than the simple anterior approach in the context of severe instability of cervical spine fracture. [17,18] And some reports showed that the internal fixation by modified posterior approach plus instrument wearing improved the efficacy of the cervical fracture treatment.…”

Section: Introductionmentioning

confidence: 99%

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One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

Xie

Cai

et al. 2017

Medicine

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The aim of the article is to investigate the efficacy and safety of 1-stage surgical therapy via combined anterior–posterior approach on cervical spine fracture in patients with ankylosing spondylitis (AS).We retrospectively analyzed profiles of 12 AS patients with severe fracture-dislocation of cervical spine received 1-stage combined anterior–posterior surgery in our hospital from October, 2013, to October, 2015, including clinical characteristics, follow-up data, and imaging records. We compared the parameters before and after surgery on the basis of neurological function, bone fusion, Cobb angles of operation segment, Barthel index (BI) score, and incidence rate of complications.A total of 12 patients received 1-stage surgery via combined anterior–posterior approach within 3 days after injury. No severe complications and death occurred. All patients received the successfully anatomical reduction of fracture-dislocation, in which 9 achieved function restoration. The latest follow-up showed the neurological function status of patients was improved. The Cobb angles of operation segments were recovered; the rate of bone fusion was 66.7% at 3 months and 100% at 6 months post-operation. The BI score was improved, 4 cases of moderate dependence and 8 of slight dependence at the latest follow-up compared to 10 of severe dependence and 2 of moderate dependence preoperation. In no cases did severe complications from implanted instrumentation occur.It was high efficacy and safety that the surgical therapy was performed on cervical fracture-dislocation in AS patients by the 1-stage combined anterior–posterior approach. The key of the surgery is the robust stabilization and full decompression of fracture spine at early stage. In addition, if spinal anatomical reduction of fracture segments is difficult to be achieved, the functional restoration should be adopted during the surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

Xie

Cai

et al. 2017

Medicine

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“…There is a dilemma in the literature, whether these injuries needs to be treated aggressively or a conservative approach is more optimal. [1][2][3][4][5][6][16][17][18] As morbidity and mortality associated with esophageal perforation is high, timely diagnosis and early institution of appropriate treatment is of paramount importance for successful outcome.…”

Section: Treatmentmentioning

confidence: 99%

Esophageal Fistula following Anterior Cervical Discectomy and Fusion in Traumatic Cervical Injury Cases: A Review

Meena

Doddamani

Sawarkar

et al. 2020

Indian Journal of Neurotrauma

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Background Esophageal fistula is a very rare complication associated with anterior approaches to the cervical spine. Timely diagnosis and early intervention are associated with favorable outcomes. There is a dilemma in the literature for its optimal management. In this review article, we will discuss the management dilemmas in patients with esophageal perforation along with an illustrative case. Material and Methods A 24-year-old male patient operated for C5–6 fracture dislocation, presented with esophageal fistula 1 month after surgery. Investigations were done to localize the site of fistula but definitive site of leak could not be identified. Patient was counselled regarding possible surgical intervention; however, patient was opted for conservative treatment. Conclusion Esophageal fistula is a very rare occurrence. Because of varied clinical presentation and frequent delay in diagnosis, a very high index of suspicion should always be kept in mind while evaluating a patient postoperatively for dysphagia. Timely diagnosis and early intervention are key to a successful outcome.

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“…The fixed screw hole spacing might not be suitable for the LCS with varied anatomical changes, and the excessive length of plates might also accelerate the degeneration of adjacent segmental intervertebral discs. Furthermore, since ATPS fixation is required to be inserted at a large inclined angle, the conventional instruments are difficult to use to meet this requirement, and a protruding screw tail also has a potential risk of esophageal complications [22–25]. Hence, more and more attention has been attached to the research and development of distinctive instruments for ATPS fixation.…”

Section: Distinctive Instruments For Atps Fixationmentioning

confidence: 99%

Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

Zhang

Gao

et al. 2019

Med Sci Monit

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The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.

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Esophageal Perforation in a Cervical Fracture Patient With Progressed Ankylosing Spondylitis

Abstract: 5.

Cited by 6 publications

References 8 publications

One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach

Esophageal Fistula following Anterior Cervical Discectomy and Fusion in Traumatic Cervical Injury Cases: A Review

Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

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