Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion

Study Design: Retrospective clinical case series. Objective: The objective of our study was to analyze a series of patients with delayed esophageal perforations following anterior cervical discectomy and fusion (ACDF) and describe their presentation, causes, and the efficacy of primary esophageal repair. Summary of Background Data: Delayed esophageal perforation after ACDF is a rare but significant complication. Methods: Patients above 18 years with esophageal perforations presenting to a single otolaryngologist from 1998 to 2023 were reviewed. Seven patients met inclusion criteria. Patients were included if they had a delayed esophageal perforation with a prior ACDF. Demographics, comorbidities, length of stay, operative details, and postoperative test results were collected. Results: The average age was 63.6±10.0 years, and 4 (57%) were female. The average time between ACDF and esophageal perforation repair was 2.25 (IQR: 7) years. Patients presented with symptoms of dysphagia, dysphonia, neck abscesses, cutaneous fistula, and/or neck pain. Proposed reasons for esophageal perforation included exposed instrumentation on endoscopy (N=2), anterior displacement of instrumentation (N=2), instrumentation malposition (N=1), failure and infection of instrumentation (N=1), and adherence of plate to pharyngoesophageal segments causing perforation upon mobilization (N=1). All patients were successfully treated with instrumentation removal followed by primary closure of the esophageal defect. The average length of follow-up from esophageal repair surgery was 464.4±443.4 days. The median length of follow-up from prior ACDF was 4.25 (IQR: 6.75) years. Conclusions: This study demonstrates that delayed esophageal perforation is a significant postoperative complication of ACDFs but can be effectively treated through instrumentation removal and primary closure. Careful observation of symptoms post-ACDF and immediate evaluation upon present symptoms is paramount to managing esophageal perforations.