A case report of delayed pharyngeal perforation after anterior cervical spine surgery

Abstract

We report a case of delayed pharyngeal perforation, a rare complication of anterior cervical spine surgery, which was successfully treated by the closure of the perforated pharynx. A 62-year-old male patient presented with dysphagia. Six years earlier, he had undergone an anterior cervical spine surgery for ossification of posterior longitudinal ligament. Eight months after the initial presentation, he had further difficulty in swallowing and needed to change his diet to a grueling diet and crush his oral medication. He was admitted to the internal medicine department when fluid intake became difficult. Upper gastrointestinal endoscopy revealed that the anterior cervical spine plate was exposed at the esophageal orifice, leading to a diagnosis of delayed pharyngeal perforation caused by the plate. He was then referred to our department. We withdrew the plate, closed the pharyngeal perforation by simple suture, and applied a sternohyoid muscle flap to reinforce the closure. The patient had no complications postoperatively, and swallowing rehabilitation was started two weeks after the surgery. The patient initially received tube feeding, but recovered to the level of full oral intake by one month after surgery. Perforation of the pharynx or esophagus is well known as a serious complication of anterior cervical spine surgery, but there are few reports of delayed occurrence. Although closure using free tissue fragments or two-stage surgery should be considered depending on the size and location of the perforation and the underlying condition of the patient, in the present case, it was possible to treat the patient with a single-stage minimally invasive surgery without causing pharyngeal stenosis or postoperative re-perforation.