Esophageal Perforation after Anterior Cervical Spine Surgery

Objective To report our updated experience in the management of esophageal perforation resulting from anterior cervical spine surgery (ACSS), and to compare two wound management approaches. Methods This is a retrospective review of patients managed for esophageal perforations resulting from ACSS (2007 – 2020). We examine outcomes based on 2 wound management approaches: closed (closed incision over a drain) versus open (left open to heal by secondary intention). We collected data on demographics, operative management, resolution (resumption of oral intake), time to resolution, number of procedures needed for resolution, microbiology, length of stay and neck morbidity. Results A total of 13 patients were included (10 male). Median age was 52 years (range: 24 – 74). All patients underwent surgical drainage, repair or attempted repair of perforation, hardware removal, and establishment of enteral access. Wounds were managed closed vs. open (6 closed, 7 open). There were 2 early postoperative deaths due to ARDS and aspiration (open group), and one patient was lost to follow-up (closed group). Among the remaining 10 patients: resolution rate was 80% vs. 100%, resolution in ≤ 30 days was 20% vs 100%, median number of procedures needed for resolution was 3 vs. 1, and median hospital stay was 23 vs 14 days, for the closed and open groups respectively. Conclusions Esophageal perforation following ACSS should be managed in a multidisciplinary fashion with surgical neck drainage, primary repair when feasible, hardware removal, and establishment of enteral access. We advocate open neck wound management to decrease the time-to-resolution, number of procedures, and length of stay.