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Song, Kim, Park, and Lee: Esophageal Fistula Formation by Metal Loosening following Anterior Cervical Arthrodesis - A Case Report -
Case Report
Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(3): 404-409.

Published online: 30 June 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.3.404

Esophageal Fistula Formation by Metal Loosening following Anterior Cervical Arthrodesis - A Case Report -

Kyung-Jin Song, M.D., Kyu-Hyung Kim, M.D., Jong-Hyuk Park, M.D., Jun-Mo Lee, M.D.

Department of Orthopaedic Surgery, College of Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

Address reprint requests to Kyung-Jin Song, M.D Department of Orthopaedic Surgery, Chonbuk National University Hospital, 634-18, Geumam-dong, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82.63-250-1760, Fax: +82.63-271-6538, kysong@chonbuk.ac.kr

Copyright © 2007 The Korean Orthopaedic Association

Abstract

An esophageal injury after an anterior cervical discectomy and fusion with plating is a well known but a fatal complication. If the diagnosis is delayed, inflammation can spread out into the neighboring main organs resulting in a very poor prognosis despite vigorous treatment. W e report a case of esophageal fistula formation as a result of infected metal loosening after an anterior cervical discectomy and fusion with plating, which was treated successfully with a satisfactory clinical outcome.

Keywords: Esophageal fistula, Anterior cervical fusion, Metal loosening

Figures and Tables

Fig. 1
Radiographs immediately after the index operation at a local clinic shows a normal sagittal alignment with cages and plate in the correct position.
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Fig. 2
Radiographs 8 months after the index operation; back-out of screws, one screw lost after the index surgery with suspicious infectious loosening. The white arrow indicates gas in the pouch at the midportion of the plate.
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Fig. 3
Follow-up radiograph of plain film at the secondary visit. Radiographs 18 months after the index operation; back-out of screws, another screw lost after the index surgery and progressive infectious loosening. The white arrow indicates gas in the pouch at the lower part of the plate.
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Fig. 4
Initial esophagogram taken 8 days after revision surgery. An approximately 6 mm sized esophageal fistula in esophagopharyngeal junction and an approximately 7 cm sized barium collection in the left sided paraesophageal region.
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Fig. 5
Follow-up esophagogram taken 4 weeks after Levintube insertion. The esophageal fistula size had decreased and was approximately 1.8 cm in size lined pouch located at the esophagopharyngeal junction site.
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Fig. 6
Last follow-up plain radiographs showing solid fusion with a normal sagittal alignment 12 months after revision surgery.
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References

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2. Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW. Esophageal perforations after anterior cervical surgery. J Spinal Disord. 2000. 13:77–84.
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3. Jones WG 2nd, Ginsberg RJ. Esophageal perforation: a continuing challenge. Ann Thorac Surg. 1992. 53:534–543.
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4. Tew JM Jr, Mayfield FH. Complications of surgery of the anterior cervical spine. Clin Neurosurg. 1976. 23:424–434.
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5. Yee GK, Terry AF. Esophageal penetration by an anterior cervical fixation device. A case report. Spine. 1993. 18:522–527.
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