Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes

Objective: To report about the diagnosis, surgical treatment, and postoperative management of pharyngo-esophageal perforations (PEPs) after anterior cervical spine (ACS) surgery in 17 patients. Methods: A retrospective multicenter case series of patients surgically treated for PEP after ACS surgery was performed. Data regarding cervical spine pathology and surgery, comorbidities, diagnosis and surgical management of PEP, airway management, antibiotic therapy, postoperative course, and feeding route after repair surgery at discharge and last follow-up were collected. Results: Seventeen patients were included in the study, for a total of 22 surgical procedures for PEP repair. Seven PEPs (41%) had early onset, whereas 10 (59%) were delayed. All patients underwent PEP surgical repair through an anterior prevascular retrovisceral cervicotomic approach, consisting of multiple layer sutures of the perforation, with flap interposition. Despite the challenging management of these patients, 16 of 17 patients from our series restored oral feeding. Conclusions: PEPs are among the most appalling complications of cervical spine surgery. Because of their rarity and heterogeneous presentation, a standardized management is difficult to define. From our experience with the largest case series in the literature, a multidisciplinary approach is advisable to deal with these patients.