C0231 - Progressive Dysphagia in Patient With Cervical Plate Complicated With Posterior Pharyngeal Wall Erosion

Davood K. Hosseini, MD, Tyler Schoch, MS, Lesley Philip, MD, Nilesh Shukla, MD
Hackensack University Medical Center, Hackensack, NJ

Introduction: The incidence of esophageal perforation following anterior cervical spine surgery is reported to be between 0.02 and 1.49% with mortality rate around 6 percent (1). Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation (2). Diagnosis can be made with cervical radiographs, however negative imaging does not rule out esophageal injury and further evaluation with surgical exploration warranted in the presence of high clinical suspicion.

Case Description/Methods: A 58-year old male patient with past medical history significant for Parkinson’s disease, and solitary cervical spinal sarcoma who underwent corpectomy, fusion of C3-C6 with cervical fixation plate placement and stereotactic body radiation therapy, presented with three weeks history of dysphagia, concomitant with weakness, diplopia, and weakness. Initial work up, revealed aerodigestive tract soft tissue enhancement in the cervical magnetic resonance imaging (MRI). Dysphagia progressed during the course of hospitalization and complicated with aspiration pneumonia and respiratory failure requiring intubation and mechanical ventilation. Patient subsequently underwent endoscopic gastroesophageal duodenoscopy (EGD) for further evaluation and PEG placement, which revealed posterior pharyngeal wall, and upper cervical esophageal erosion and presence of cervical fixation plate in the hypopharynx (Figure 1). Patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms.

Discussion: Our patient presented with progressive dysphagia as delayed manifestation of posterior pharyngeal wall erosion. EGD revealed the diagnosis and patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms. There are few cases reported in the literature with esophageal perforation following anterior cervical spine surgery. Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation.


Disclosures:


Davood K. Hosseini, MD, Tyler Schoch, MS, Lesley Philip, MD, Nilesh Shukla, MD. C0231 - Progressive Dysphagia in Patient With Cervical Plate Complicated With Posterior Pharyngeal Wall Erosion, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.