Esophageal fistula after anterior cervical spine fixation: First level trauma center experience

Abstract text (incl. references and figure legends)

Pharyngoesophageal fistula (PEF) is a rare but life-threatening complication after anterior cervical spine fixation (ACSF) in cervical spine injuries. In literature, there is a lack of consensus on PEF management. This study aims to evaluate the management of PEF in major trauma patients.

A retrospective analysis was performed. All patients referred to ASST Niguarda Hospital in Milan for PEF following ACSF between January 2015 and September 2022 were included. Different types of management were described, and outcomes were reported.

Four cervical spine trauma patients were referred to our center for PEF following ACSF. Their mean age was 15.5 (SD±8.01). Three reported fractures of C5 and C6 in three patients, and one had anterolisthesis of C4-C5 associated with rupture of the anterior and posterior ligament from C4 to C7. PEF showed up fourteen days after ACSF in two patients and thirty days in the other two. The first treatment of choice was different in each case. Conservative management with endoscopic procedures such as a stent or endo-sponge placement were bridges to surgery. In the end, all four patients underwent surgery. The most common approach was a direct double-layer suture covered with a left sternocleidomastoid flap (75%). Complete healing of the fistula was achieved in 3 patients, and in one, a permanent cervical esophagostomy was necessary.

The management of patients with PEF after ACSF is complex, and carrying them to a tertiary referral center with a multidisciplinary approach should be considered early.

References:

Ghirelli et al Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes.World Neurosurg.2020 Jul;139:e463-e473 Yuan et al Treatment for early postoperative esophageal fistula complicated with anterior cervical surgery. JOrthopSurg (Hong Kong).2017 Jan;25(1) Vogel et al Esophageal perforation in adults,aggressive,conservative treatment lowers morbidity and mortality. AnnSurg 2005;241:1016–1023

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