Delayed presentation of esophageal perforation from anterior cervical discectomy and fusion hardware failure in a patient presenting with non-ST-elevation myocardial infarction: An illustrative technical note

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Abstract
Background: A 69-year-old male, who underwent a C5-T1 ACDF 5-years prior to arrival, presented with a ventral pharyngeal abscess and esophageal perforation warranting major gastro-esophageal surgery and instrumentation removal. Methods: The case of a patient who underwent a C5-T1 ACDF five years ago was reviewed. A review of past reports of cases of patients who experienced esophageal erosion or perforation following ACDF was conducted. Results: At the age of 69, the patient acutely developed disorientation/agitation and urinary/fecal incontinence. Lab studies showed leukocytosis, an elevated creatine phosphokinase (CPK), and lactic acidosis, while the EKG confirmed a non-ST-elevation myocardial infarction (NSTEMI) with increased troponins. An esophagram revealed esophageal perforation, and a prevertebral C5-C6 abscess, and neck/thoracic CT studies documented 8-9 mm anterior displacement of the right inferior C7 screw with extravasation extending inferiorly into the mediastinum. Surgery consisted of an esophagogastroduodenoscopy, gastric/jejunal tube placement, left neck exploration, and dissection of the esophagus off the anterior instrumentation that was subsequently removed. Despite emergent surgical intervention, the patient expired 5 days postoperatively. Conclusion: Neurosurgical follow-up is warranted in ACDF patients who newly present with findings indicative of with anterior retropharyngeal abscess or esophageal perforation.

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