Management of cervical esophageal injury after spinal surgery
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Esophageal injury is a rare but catastrophic complication of anterior cervical spine surgery. Cases of esophageal perforation may be discovered intraoperatively, or as late as 10 years after surgery. In the current study we aim to review the principles of care and provide an algorithm that can be employed for successful management of this complex problem.
METHODS: We performed a retrospective, Institutional Review Board-approved review of esophageal injuries resulting from anterior cervical spine surgery that were managed at our institution between January 1, 2007 and July 31, 2009. We collected demographic information, perioperative data, and final outcomes. Data were analyzed using descriptive statistics.
RESULTS: We identified 6 patients who met our criteria. All patients presented with esophageal leaks, neck abscesses, and osteomyelitis. Similarly, all had been treated prior to transfer, without resolution of their leak. After debridement, removal of hardware, long-term antibiotic therapy, maximization of nutrition, and supportive care, 80% of patients resumed oral intake (median time 66.5 days). Mortality was 16.7%.
CONCLUSIONS: Neck exploration with removal of hardware, debridement, and open neck wound management are the basic principles of care. Management is often prolonged and requires multiple procedures; however, with persistence, closure is possible in the majority of patients. Our report serves as a guide for the treatment of this devastating problem.
| Errataetall: |
CommentIn: Ann Thorac Surg. 2011 Sep;92(3):1159-60; author reply 1160. - PMID 21871339 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2010 |
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| Erschienen: |
2010 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:90 |
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| Enthalten in: |
The Annals of thoracic surgery - 90(2010), 4 vom: 15. Okt., Seite 1128-33 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rueth, Natasha [VerfasserIn] |
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Date Completed 21.10.2010 Date Revised 17.11.2011 published: Print CommentIn: Ann Thorac Surg. 2011 Sep;92(3):1159-60; author reply 1160. - PMID 21871339 Citation Status MEDLINE |
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| doi: |
10.1016/j.athoracsur.2010.06.045 |
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| PPN (Katalog-ID): |
NLM20183216X |
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| 500 | |a CommentIn: Ann Thorac Surg. 2011 Sep;92(3):1159-60; author reply 1160. - PMID 21871339 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Esophageal injury is a rare but catastrophic complication of anterior cervical spine surgery. Cases of esophageal perforation may be discovered intraoperatively, or as late as 10 years after surgery. In the current study we aim to review the principles of care and provide an algorithm that can be employed for successful management of this complex problem | ||
| 520 | |a METHODS: We performed a retrospective, Institutional Review Board-approved review of esophageal injuries resulting from anterior cervical spine surgery that were managed at our institution between January 1, 2007 and July 31, 2009. We collected demographic information, perioperative data, and final outcomes. Data were analyzed using descriptive statistics | ||
| 520 | |a RESULTS: We identified 6 patients who met our criteria. All patients presented with esophageal leaks, neck abscesses, and osteomyelitis. Similarly, all had been treated prior to transfer, without resolution of their leak. After debridement, removal of hardware, long-term antibiotic therapy, maximization of nutrition, and supportive care, 80% of patients resumed oral intake (median time 66.5 days). Mortality was 16.7% | ||
| 520 | |a CONCLUSIONS: Neck exploration with removal of hardware, debridement, and open neck wound management are the basic principles of care. Management is often prolonged and requires multiple procedures; however, with persistence, closure is possible in the majority of patients. Our report serves as a guide for the treatment of this devastating problem | ||
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