Expert Head and Neck Surgeon Opines on Esophageal Perforation Following Spinal Fusion Procedure

    Head and Neck Surgery Expert WitnessThis case involves a female patient who underwent a fusion procedure on her cervical spine. Following the surgery, the patient was noted to be unable to swallow. Treatment was rendered conservatively, with attempts made to correct the issue through the use of a swallowing technique, however these efforts proved fruitless and a feeding tube was placed. The patient’s condition continued to deteriorate over the course of several months, with no improvement in her ability to swallow, as well as the development of worsening pain in the patient’s neck. After seeking a second opinion and undergoing an MRI, it was discovered that the patient was suffering from widespread infection of her neck vertebrae. An operation was undertaken to address the infection, during which it was discovered that the esophagus had a perforation that was connected to the cervical spine. It was alleged that earlier surgical intervention would have prevented the infection and greatly improved the patient’s outcome.

    Question(s) For Expert Witness

    • 1. Do you routinely treat patients with esophageal punctures?

    Expert Witness Response E-001733

    I have extensive experience with assisting neurosurgeons in performing anterior cervical spine surgery. Esophageal perforation is a known complication of this procedure. With prompt recognition and primary repair the morbidity is typically minimal. In regards to the management of the esophageal injury/fistula, a brief period of expectant management (waiting for it to close), can be appropriate, but in this setting most would probably advocate for surgical intervention on the earlier side, maybe 1-2 weeks. Certainly I think at 1 month I would advocate surgical exploration. The osteomyelitis is likely from the chronic fistula, and the exposure of the bone to saliva, etc. Neurosurgeons and orthopedic spine surgeons are generally, and wisely, very concerned about infection in the setting of hardware adapted to bone; the timeline described does not seem to be in keeping with that.

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