Pharyngoesophageal diverticulum perforation 18 years after anterior cervical fixation

Almre, Ingemar; Asser, Andres; Laisaar, Tanel

doi:10.1093/icvts/ivt421

Cited by 23 publications

(22 citation statements)

References 5 publications

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“…One patient had primary closure with redundant mucosa from the diverticulum, and the final patient declining intervention. This is consistent with previous investigators, who have reported pharyngeal repair with sternocleidomastoid, sternohyoid, and omohyoid muscle flaps …”

Section: Discussionsupporting

confidence: 94%

“…The first reported case of a traction diverticulum caused by ACSS was the result of an adherence of the hypopharyngeal mucosa to a bone graft in a patient after fusion of a C6 and C7 fracture and dislocation . Since then, 22 cases have been reported in the literature . Presentation has been varied, with some patients presenting a few months after ACSS and some identified as late as 18 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Since the initial description of Zenker's‐like traction diverticulum (ZTD), various case reports have highlighted the misdiagnosis of ZTD as typical ZD, the presence of exposed cervical hardware, and patient mortality. However, there are no reported series comparing outcomes of ZTD to ZD patients or any studies comparing these two distinct pathologies with a VFSS . The purpose of this investigation was to compare objective fluoroscopic findings and surgical outcomes in persons with ZTD to age‐ and gender‐matched patients with traditional ZD.…”

Section: Introductionmentioning

confidence: 99%

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Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

et al. 2019

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Objectives: A Zenker's diverticulum (ZD) is a hypopharyngeal pulsion diverticula caused by dysfunction of the cricopharyngeus muscle with herniation of hypopharyngeal mucosa through Killian's dehiscence. Anterior cervical spine surgery (ACSS) can cause a Zenker's-like traction diverticulum (ZTD) with a similar presentation but different pathophysiology. The purpose of this investigation was to compare the fluoroscopic parameters and surgical outcomes of ZTD after ACSS to those of typical ZD.Study Design: Case-control study. Methods: The charts of patients undergoing a videofluoroscopic swallow study after ACSS between January 1, 2014, and January 1, 2018, were evaluated for evidence of ZTD. Patients with ZTD were age and gender matched to persons with ZD. Fluoroscopic parameters and patient-reported outcomes were compared between groups.Results: Eleven patients with ZTD were identified. The mean pharyngeal constriction ratio (PCR) was significantly higher for persons with ZTD (0.87 [AE0.07] vs. 0.17 [AE0.08]; P < 0.05). Mean hyolaryngeal elevation was significantly less (2.5 [AE0.9] cm vs. 3.5 [AE0.7] cm) and mean diverticulum size significantly smaller (1.3 [AE1.0] cm vs. 2.3 [AE2.0] cm) for persons with ZTD (P < 0.05). Five ZTD patients had exposed hardware necessitating open approach for removal.Conclusion: We report the largest cohort of ZTD after ACSS. ZTD are smaller than traditional Zenker's and associated with more pharyngeal weakness, poorer laryngeal elevation, and worse treatment outcomes. Although these diverticula can be managed endoscopically, the high percentage of exposed cervical hardware necessitates a thorough preoperative assessment and frequent need for open management and pharyngeal repair.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

et al. 2019

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“…All duplicate articles, abstracts, review articles, and letters to the editor were excluded. [1][2][3][4][5]8,10,[13][14][15][16][17][18][20][21][22][23][60][61][62]64,65,[67][68][69][70][71][72][73][74][75] Title and abstract review was performed once the initial list of studies was generated (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature

Halani

Baum

Riley

et al. 2016

SPI

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OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14–85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5–6 (n = 51) and C6–7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included pneumonia (n = 6), mediastinitis (n = 4), osteomyelitis (n = 3), sepsis (n = 3), acute respiratory distress syndrome (n = 2), and recurrent laryngeal nerve damage (n = 1). The mortality rate of esophageal perforation in the analysis was 3.92% (6 of 153 reported patients). CONCLUSIONS Esophageal perforation after anterior cervical spine surgery is a rare complication. This systematic review demonstrates that these perforations can be stratified into 3 categories based on the timing of symptomatic onset: intraoperative, early postoperative (within 30 days of anterior spinal surgery), and delayed. The most common source of esophageal injury is hardware erosion or migration, each of which may vary in their time to symptomatic manifestation.

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“…Symptoms include fever, neck pain, crepitus, dysphagia, hoarseness, leukocytosis and can lead to wound drainage, pharyngeal abscess and subcutaneous emphysema [ 3 , 4 ]. It is more uncommon for such a problem to present at a later time [ [5] , [6] , [7] ].…”

Section: Introductionmentioning

confidence: 99%

Migration of spinal pedicle screw with aerodigestive perforation and subsequent device expectoration

Leiva‐Juárez

Greenberg

Punzina

2018

International Journal of Surgery Case Reports

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IntroductionSpinal fixation is a common surgical procedure. Frequently, fixation for spinal stabilization requires use of instrumentation such as pedicle screws and fixation plates. Aerodigestive and vascular perforations from such procedures are infrequent albeit known complications from these procedures.Presentation of caseThis case details an uncommon situation in which a patient with anterior cervical spine fixation in the distant past was found to have a migratory pedicle screw. The patient had symptoms of neck pain and dysphagia. Radiographic studies were helpful in demonstrating the problem. While undergoing a physical examination, the patient was witnessed to expectorate the screw. Further work up with panendoscopy was undertaken and the patient managed conservatively.DiscussionThe upper aerodigestive system rarely experiences perforation from spinal stabilization hardware. When it occurs, management should include a dedicated investigation of the involved portions of the digestive system to avoid further complication.ConclusionThis case presents an rare occurrence of aerodigestive perforation of a spinal pedicle screw which was self-removed.

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Pharyngoesophageal diverticulum perforation 18 years after anterior cervical fixation

Cited by 23 publications

References 5 publications

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature

Migration of spinal pedicle screw with aerodigestive perforation and subsequent device expectoration

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