SCI
Cameron Widhalm, DO
PM&R resident
Casa Colina
Pomona, California, United States
Petro Zaroukian, MD
Resident Physician
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Brian Khin, DO
PM&R Resident
Casa Colina
Arcadia, California, United States
Brian Vu, MD
resident physician
Casa Colina Hospital
Chino Hills, California, United States
Emmanuel Villalpando, MD
resident physician
Casa Colina Hospital
Pomona, California, United States
Hunter Goldsmith, MD
PM&R Resident
Casa Colina
Pomona, California, United States
Cameron Widhalm, BS
Western University of Health Sciences
Pomona, California, United States
41 year-old male with a C4 ASIA B spinal cord injury secondary to motor vehicle accident five years prior and status post C4 -T2 spinal fusion presenting with late effect esophageal perforation.
Case Description:
The patient was admitted to acute rehabilitation for functional decline secondary to sepsis from urinary source. The patient was continued on antibiotics however still developed intermittent constitutional symptoms. The patient also endorsed a subjective cold sensation in his throat when drinking water. Record review showed that a year and a half ago, he developed recurrent neck abscesses around his cervical surgical site, requiring antibiotics. We then ordered an esophagram which was negative for esophageal extravasation. Blood cultures grew both MRSA and fusobacterium. CT neck revealed soft tissue thickening around upper thoracic vertebral bodies with possible esophageal connection fistula. ENT and neurosurgery took the patient in for an endoscopy, which revealed an esophageal perforation with exposed spinal hardware and paraspinal abscess, requiring hardware revision and incision and drainage.
Discussions:
The incidence of esophageal perforation following cervical fixation is between 0.02% to 1.62%, with most being diagnosed within a median of 44.5 days. Morbidity and mortality rates remain high, as perforations detected and treated within 24 hours have mortality rates reported at 20%. Current literature describes rare cases of esophageal perforations years after initial cervical fixation. Most patients present with nondescript symptoms: neck pain, dysphagia, or pneumonia. Initial imaging can often be negative or equivocal, necessitating repeat studies with confirmation from esophagram or endoscopy. Our case highlights the importance of a thorough workup for non-descript symptoms, in patients with a history of cervical fixation.
Conclusions:
Patients with a history of cervical fixation who present with vague pharyngeal complaints with concurrent refractory infections should raise suspicion for pharyngoesophageal perforation from spinal hardware.
