Treatment of pharyngoesophageal injuries in cervical spine surgery

Abstract

Esophageal injury is a feared complication of anterior cervical surgery. The esophageal/hypopharyngeal complex forms the deep medial aspect of the approach to the anterior cervical spine and is vulnerable to injury by sharp instruments. Esophageal injuries may be recognized acutely but frequently present in a delayed fashion. Many injuries are the result of chronic erosion, often from migrated instrumentation. Patients with esophageal perforations may present with a constellation of symptoms ranging from mild swallowing discomfort to prevertebral abscess and sepsis. Prevention is key to avoiding morbidity related to this complication. Diagnosis of esophageal injuries in patients with a history of anterior cervical spine surgery can be challenging. When an injury is discovered, a multidisciplinary approach to treatment involving a head and neck surgeon is imperative. This chapter will cover diagnostic strategies for detecting esophageal injuries as well as potential treatment options. The author's preferred method for treatment is outlined along with an illustrative case.