Management of Esophageal Perforation Post Cervical Disc Replacement With Endoscopic Clips
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Esophageal perforation is one of the most challenging complications related to anterior cervical spine surgery. Although the perioperative complication profile of anterior cervical disc replacement (ACDR) is similar to anterior cervical discectomy and fusion (ACDF), esophageal perforation and its management have not been reported in the setting of ACDR. Case Report: We present a case of a 61-year-old woman who experienced delayed esophageal perforation five weeks after ACDR. She presented to the emergency department with severe neck pain, dysphagia, dysphonia, and subcutaneous emphysema. Gastrografin swallow study and esophagogastroduodenoscopy (EGD) demonstrated a small (<1 cm) esophageal tear. This defect was successfully repaired with an endoscopic clip without the need for a vascularized flap. Surgical anterior neck exploration confirmed adequate esophageal repair and well-fixated hardware. Early oral intake was initiated on hospital day 8, and the patient was discharged home on antibiotics by day 10. The endoscopic clip was successfully removed after eight weeks. The prosthetic disc was preserved and continued to function at one-year follow-up after the index operation. Discussion: Esophageal perforation after anterior cervical spine surgery is a rare complication that carries high mortality rates, especially in delayed cases. Early diagnosis and intervention are key to alleviating morbidity associated with this injury. Current operative management includes direct repair augmented with vascularized flaps. This is typically accompanied by delayed oral intake and often requires the placement of a gastroenteric feeding tube. Successful esophageal repair was achieved in this case with the use of an endoscopic clip without the use of a vascularized flap. This treatment allowed for early oral feeding and quicker hospital discharge. Conclusions: Successful esophageal repair using an endoscopic clip was performed in this case of delayed esophageal perforation after ACDR. Endoscopic repair without the need for a vascularized flap may be advantageous in the setting of small tears and low-profile construct designs as they offer quicker recovery and early oral nutrition in comparison to direct repair augmented with vascularized flaps.
Source: Spine Open
Institution: Dignity Health
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7127895492