Pharyngo-esophageal perforations after anterior cervical spine surgery: management and outcomes.

ABSTRACT Objective To report about the diagnosis, surgical treatment and post-operative management of pharyngo-esophageal perforations (PEP) after anterior cervical spine (ACS) surgery in 17 patients. Methods: A retrospective multi-center 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, post-operative course, feeding route after repair surgery, at discharge and at last follow-up were collected. Results Seventeen patients were included in the present study, for an overall number of 22 surgical procedures for PEP repair. Seven PEPs (41%) had early onset, while 10 (59%) were delayed. All patients underwent PEP surgical repair through an anterior prevascular retrovisceral cervicotomic approach, consisting of a multiple layer suture of the perforation, with flap interposition. Despite the challenging management of these patients, 16 over 17 from our series restored the oral feeding. Conclusion PEPs are among the most appalling complications of CS surgery. Because of their rarity and heterogeneous presentation, a standardized management is difficult to define. From the authors’ experience on the widest case series in the literature, a multidisciplinary approach is advisable to deal with these patients.