PDF herunterladen
J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 546-548
DOI: 10.1055/s-0040-1710547
Technical Note

Covering of Plate after Anterior Cervical Fusion in Patients with Complete Spinal Cord Injury to Prevent Esophageal Injury: Technical Note

Saeed Oraee-Yazdani 
1   Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Maryam Golmohammadi
1   Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Mohammadhosein Akhlaghpasand
1   Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Maryam Oraee-Yazdani
1   Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background Esophageal injury after anterior corpectomy and fusion is a rare but life-threatening complication. It may cause mediastinitis due to anatomical continuity between the retropharyngeal space and the mediastinum, with reported high mortality rates. The acute and subacute injuries are most commonly of iatrogenic origin, while late perforation has been described several weeks to years later as a result of continuous friction or pressure of the instruments against the posterior wall of the esophagus, leading to ischemia and necrosis. This phenomenon is more common among quadriplegic patients who have undergone corpectomy and insertion of expandable or mesh cages and plate probably due to chronic erosion by hardware at the supine position.

Methods Since 2015, we have applied the technique of using a patch of autologous fascia lata to cover the anterior cervical plate by suturing to the longus colli muscles in 58 quadriplegic patients; the mean follow-up was 35.2 (28–41) months.

Results Since we started using this procedure, based on our follow-up at our center, there have been no cases of late esophageal perforation among quadriplegic patients.

Conclusion As a technical note, it seems like this method would be able to reduce the prevalence of esophagus injury among quadriplegic patients. However, to substantiate the efficacy of this technique, long-term follow-up and larger sample size are needed because esophageal injury occurs rarely.

Keywords

cervical spinal cord injury - quadriplegia - esophageal perforation - anterior fixation


Publikationsverlauf

Eingereicht: 04. Juni 2019

Angenommen: 20. Dezember 2019

Artikel online veröffentlicht:
10. September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958; 15 (06) 602-617
    CrossrefPubMedGoogle Scholar
  • 2 Chen C-C, Huang Y-C, Lee S-T, Chen J-F, Wu C-T, Tu P-H. Long-term result of vocal cord paralysis after anterior cervical disectomy. Eur Spine J 2014; 23 (03) 622-626
    CrossrefPubMedGoogle Scholar
  • 3 Burke JP, Gerszten PC, Welch WC. Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 2005; 5 (05) 508-514 , discussion 514
    CrossrefPubMedGoogle Scholar
  • 4 Kelly MF, Spiegel J, Rizzo KA, Zwillenberg D. Delayed pharyngoesophageal perforation: a complication of anterior spine surgery. Ann Otol Rhinol Laryngol 1991; 100 (03) 201-205
    CrossrefPubMedGoogle Scholar
  • 5 Newhouse KE, Lindsey RW, Clark CR, Lieponis J, Murphy MJ. Esophageal perforation following anterior cervical spine surgery. Spine 1989; 14 (10) 1051-1053
    CrossrefPubMedGoogle Scholar
  • 6 Hershman SH, Kunkle WA, Kelly MP. et al. Esophageal perforation following anterior cervical spine surgery: case report and review of the literature. Global Spine J 2017; 7 (1, Suppl): 28S-36S
    CrossrefPubMedGoogle Scholar
  • 7 Halani SH, Baum GR, Riley JP. et al. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine 2016; 25 (03) 285-291
    CrossrefPubMedGoogle Scholar
  • 8 Yang S-Y, Lee S-B, Cho K-S. Delayed esophagus perforation after anterior cervical spine surgery. Korean J Neurotrauma 2015; 11 (02) 191-194
    CrossrefPubMedGoogle Scholar
  • 9 Coelho R, Ekberg T, Svensson M, Mani M, Rodriguez-Lorenzo A. Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: a case report. Microsurgery 2017; 37 (06) 684-688
    CrossrefPubMedGoogle Scholar
  • 10 English GM, Hsu S-F, Edgar R, Gibson-Eccles M. Oesophageal trauma in patients with spinal cord injury. Paraplegia 1992; 30: 903-912
    CrossrefPubMedGoogle Scholar
  • 11 Sharma RR, Sethu AU, Lad SD, Turel KE, Pawar SJ. Pharyngeal perforation and spontaneous extrusion of the cervical graft with its fixation device: a late complication of C2-C3 fusion via anterior approach. J Clin Neurosci 2001; 8 (05) 464-468
    CrossrefPubMedGoogle Scholar
  • 12 Krishnan P, Kartikueyan R, Patel SM, Bose PP, Mukherjee KK. Two cases of esophageal injury following anterior cervical discectomy and fusion: one overt and one covert. Ann Neurosci 2017; 24 (02) 126-130
    CrossrefPubMedGoogle Scholar
  • 13 Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW. Esophageal perforations after anterior cervical surgery. J Spinal Disord 2000; 13 (01) 77-84
    CrossrefPubMedGoogle Scholar
  • 14 Gupta NM, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004; 187 (01) 58-63
    CrossrefPubMedGoogle Scholar
  • 15 Navarro R, Javahery R, Eismont F. et al. The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery. Spine 2005; 30 (20) E617-E622
    CrossrefPubMedGoogle Scholar
  • 16 Ahn S-H, Lee S-H, Kim ES, Eoh W. Successful repair of esophageal perforation after anterior cervical fusion for cervical spine fracture. J Clin Neurosci 2011; 18 (10) 1374-1380
    CrossrefPubMedGoogle Scholar
  • 17 Hanwright PJ, Purnell CA, Dumanian GA. Flap reconstruction for esophageal perforation complicating anterior cervical spinal fusion: an 18-year experience. Plast Reconstr Surg Glob Open 2015; 3 (05) e400
    CrossrefPubMedGoogle Scholar