We report a delayed postoperative injury to the esophagus in a patient who underwent cervical corpectomy for spondylodiscitis. The patient was a 72-year-old man. He was diagnosed by magnetic resonance imaging with spondylodiscitis at C5/6/7, with an epidural abscess at C5/6/7, and ossification of the posterior longitudinal ligament from C2 to C7. For surgical treatment, corpectomy and interbody fusion with a mesh cage at C5/6, an anterior plate and posterior laminectomy at C3/4, posterior screw fixation at C5/6/7/T1, and anterior cervical discectomy and fusion at C3/4 were performed. After 2 weeks, blood was detected in the Levin tube drain and gastroscopy was performed. Gastroscopy confirmed that the mesh cage was exposed because of damage to the esophagus.
Cervical corpectomy and fusion are often performed to treat cervical spondylodiscitis with preoperative motor deficits [
Complications of the anterior approach to the cervical spine is include vocal cord paralysis,vascular injury,esophageal perforation, tracheal damage and infection [
Esophageal perforation is a rare complication. Estimated prevalence of esophageal injuries is 0.25% following anterior cervical surgery [
Immediate esophageal injuries have previously been reported in anterior cervical corpectomy, but reports of delayed esophageal injuries are extremely rare [
The patient was a 72-year-old male. He presented to the hospital with severe neck pain, upper extremity radicular pain, and upper and lower extremity weakness. The patient was diagnosed with spondylodiscitis at C5/6/7, an epidural abscess at C5/6/7, and ossification of the posterior longitudinal ligament from C2 to C7 based on MRI. Treatment combined antibiotic and surgical approaches (
The preoperative antibiotic was intravenously (IV) ceftriaxone 2 g for 4 days. After surgery, methicillin-resistant
The surgical treatment consisted of corpectomy at C5/6, interbody fusion with a mesh cage, an anterior plate and posterior laminectomy at C3/4, and posterior screw fixation at C5/6/7/T1 (
After surgery, symptoms improved, and the patient was discharged. After 8 months, the patient returned to the hospital with scapular pain. On computerized tomography (CT) and MRI no changes were apparent at the previously operated site (
Anterior cervical discectomy and fusion at C3/4 were performed because of the exacerbation of C3/4 intervertebral disc herniation visible in the MR images and the patient's symptoms improved afterwards (
Gastroscopy confirmed that the mesh cage was exposed because of damage to the esophagus (
Complications of anterior surgical exposure include laryngeal nerve injury, iatrogenic dysphagia, vertebral and carotid artery injuries, tracheal injury. Iatrogenic dysphagia is so frequent that it has been reported in 9.5% of cases [
Delayed injury to esophagus after anterior spine surgery has been reported. Kuriloff et al. [
In case of doubt regarding an esophagus perforation, close clinical surveillance is mandatory [
Contrast-enhanced cervicothoracic CT is sensitive in screening for mucosal perforation, visualizing indirect signs such as air or effusion and local or regional complications. Rigid endoscopy under general anesthesia, combining hypopharyngoscopy and esophagoscopy is the examination of choice for exploring esophagus wounds [
Treatment of esophagus wounds remains controversial and requires multidisciplinary discussion between surgeon, gastroenterologist and anesthetist. It is agreed that small wounds (<0.5–1 cm) that are detected early can be managed medically. In case of sepsis, surgery is mandatory [
Some spondylodiscitis patients require anterior cervical corpectomy. In this case, gastroscopy confirmed that the mesh cage and plate was exposed at corpectomy site. No perforation was observed in the anterior cervical discectomy and fusion site, only the thinned esophagus was observed. So esophageal injury was thought to be due to friction between the plate of corpectomy site and the esophagus. It is also believed that the manner of insertion of the Levin tube may have contributed to the damage.
Anatomically, the esophagus is located in front of and next to the cervical body. Therefore, the esophagus is likely to also be in a state of infection and inflammation in cervical spondylodiscitis. This reduces the thickness of the esophageal wall.
Dysphagia after upper cervical surgery is a common occurrence [
It is important to accurately identify telltale signals of esophageal injury and start treatment early in patients at a high risk of esophageal damage. Such signs of damage to the esophagus include the accumulation of mucus and phlegm when ingesting food through a Levin tube. The rise in C-reactive protein levels in blood tests is also an important indicator.
Here, we report a case of delayed esophageal injury due to corpectomy and fusion in a patient with cervical spondylodiscitis. We conclude that tube insertion in a patient who has undergone surgery for infection should be performed carefully.
No potential conflict of interest relevant to this article was reported.
Preoperative cervical magnetic resonance imaging (MRI) and computed tomography (CT) show spondylodiscitis at C5/6/7, an epidural abscess at C5/6/7, and ossification of the posterior longitudinal ligament from C2 to C7. (A) T1-weighted MRI, (B) T2-weighted MRI, (C) CT.
Anterior–posterior and lateral radiographs of the cervical spine showing the patient’s condition after corpectomy at C5/6; interbody fusion with a mesh cage, an anterior plate, and posterior laminectomy at C3/4; and posterior screw fixation at C5/6/7/T1.
Magnetic resonance imaging and computed tomography of the cervical spine showing the patient’s condition after corpectomy at C5/6 and interbody fusion with a mesh cage, an anterior plate, and posterior laminectomy at C3/4. (A) T1-weighted magnetic resonance imaging (MRI), (B) T2-weighted MRI, (C) computed tomography.
Anterior–posterior and lateral radiographs of the cervical spine showing the patient’s condition after corpectomy at C5/6; interbody fusion with a mesh cage, an anterior plate, and posterior laminectomy at C3/4; posterior screw fixation at C5/6/7/T1; and anterior cervical discectomy and fusion at C3/4.
Endoscopy revealed the exposed plate and mesh cage due to an esophageal injury.