Oesophageal Injury After Anterior Cervical Spine Surgery

Clinical Features and Presentation

Physical examination and laboratory studies alone are not reliable for early diagnosis of esophageal injury in patients after anterior cervical spine surgery 3

Contrast-enhanced CT and CT esophagography should be performed in hemodynamically stable patients with suspected esophageal injury, with high sensitivity (95%) and specificity (91%) 4
Flexible endoscopy is recommended as an adjunct to CT, providing direct visualization of the injury site and can alter surgical management in up to 69% of patients 4
In unstable patients requiring immediate surgery, intraoperative endoscopy can be employed to rule out esophageal perforation 4
Triple endoscopy (esophagoscopy, laryngoscopy, and bronchoscopy) is indicated as injury to one structure should raise suspicion of damage to adjacent organs 4

Operative repair is the treatment of choice for traumatic injuries of the esophagus, according to the American College of Surgeons 1, 2
Debridement of non-viable tissue around the perforation is a key surgical principle 2
Primary closure of the esophageal defect when feasible is recommended 2
The mucosal defect is often longer than the muscular tear; longitudinal myotomy at both ends helps expose mucosal edges for appropriate repair 1
Two-layer repair with separate suturing of the mucosa and muscle is traditionally recommended 1
Buttressing the repair with vascularized tissue (muscle flap) decreases the risk of leakage 1, 2
Adequate drainage around the repair site is necessary 1
Decompression of the esophagus and stomach via nasogastric tube is recommended 1

Non-operative management can be considered only in highly selected patients with early presentation, contained esophageal disruption, and minimal contamination of surrounding spaces 1, 4
Requires nil per os status, broad-spectrum antibiotic coverage, nasogastric tube placement, early nutritional support, and intensive monitoring in an ICU setting 1, 4

Common complications include pneumonia 2, mediastinitis 4, sepsis 1, and acute respiratory distress syndrome 4
Mortality rate ranges from 3.92% to 50% without appropriate management 2
Early diagnosis and immediate treatment are crucial for survival, as 92% of deaths occur within 24 hours 1

Treatment should be undertaken in specialized centers with multispecialty expertise (esophageal surgeons, interventional radiologists, endoscopists, intensive care specialists) 3