Algorithmic Approach to Reconstruction of Esophageal/Hypopharyngeal Injuries After Anterior Cervical Spinal Fusion

BACKGROUND: Anterior cervical disk fusion (ACDF) isa common surgical approach for the treatment of cervicalspine pathology. Esophageal perforations, though uncom-mon, are a devastating complication of this surgery. The objective of this paper is to assess the success of different treatment approaches for the management of esophageal/pharyngeal injury after ACDF. METHODS:Given the absence of prospective trials, thereview includes institutional case reports and case seriesfrom 1985e2020 in the English language literature. Onlycases of esophageal/pharyngeal injury in the setting ofanterior cervical hardware were considered for study in-clusion. For purposes of this study, treatment success isdefined as resumption of oral intake. RESULTS:The database review identified 76 distinctseries that meet criteria for study inclusion, with 173 pa-tients available for analysis. A heterogeneous array oftreatments was used for the management of phar-yngoesophageal injuries after ACDF ranging from obser-vation to complex free tissue reconstruction, with varyingdegrees of treatment success reported. We identified anumber of factors, specifically duration of injury frominitial ACDF procedure, which may impact the complexityof treatment required to maximize likelihood of treatmentsuccess. CONCLUSIONS: Pharyngoesophageal injuries, albeitrare, are a serious and often complex complication afterACDF procedures. We propose a detailed algorithmicapproach to guide decision making if faced with thisclinical challenge. The huge variability in how thesepatients are treated emphasizes the potential utility offuture multiinstitutional studies

Automated summary

This study evaluates the success of different treatment approaches for esophageal/pharyngeal injury after ACDF, finding a wide range of treatments with varying degrees of success, and highlighting the potential impact of injury duration on treatment success.