Magnet-assisted endoscopic diverticulotomy for an esophageal diverticulum after anterior cervical spine surgery: First case report

Introduction

The anterior approach to the cervical spine is used in surgical treatment of several diseases in this region. As a late complication, a true traction diverticulum can be formed in the pharyngoesophageal region [1]. First described by Goffart et al. in 1991, this complication is rare, and is most frequently associated with C5-C6 involvement [2].

Among the various etiologies, this diverticulum is mostly likely caused by inflammation with scar retraction of the surrounding tissues, which is inherent in surgical manipulation itself; this exerts traction on the wall of the pharynx and esophagus, leading to its formation. Others causes, including possible accidental injury of the pharynx and esophagus during the procedure and compression and friction of the posterior wall of the pharynx and esophagus by the plate and screws, among others, also have been discussed [3] [4] [5]. The main symptoms are dysphagia, weight loss, regurgitation, and halitosis and others symptoms associated with aspiration or perforation, such as fever, cough, odynophagia, and breathlessness [1] [5].

There is no study in the literature that compares the various treatment modalities for pharyngoesophageal diverticulum after an anterior approach to the cervical spine. In most of the cases reported, conventional surgery was performed and was very effective [6] [7]. There are few published cases on endoscopic treatment of this diverticulum. The techniques that have been used were septal stapling [1] [5] and conventional septotomy [1]; no report using magnets was found in our review.

Magnetic compression has been used in the digestive tract to create solid anastomotic connections. Regarding the procedure, two magnets are positioned to carry the apposition of two structures, which as a result of the pressure exerted on their walls, creates an inflammatory process, leading to adherence between them, followed by necrosis and consequent communication. Several diseases have been treated using this principle [8] [9] [10].

The objective of this paper was to report the first case of esophageal diverticulum post-anterior cervical spine surgery treated by endoscopy using magnets and septotomy.

Publikationsverlauf

Eingereicht: 24. September 2020

Angenommen: 07. Dezember 2020

Artikel online veröffentlicht:
27. Mai 2021

• References

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