Tyler Nicole Lackland

Baron Larrey was an 18th-century revolutionary in the field of military surgery. Serving as Napoleon Bonaparte’s trusted Surgeon-in-Chief, he utilized his inquisitive nature, alongside his experience, to develop impactful changes in the field, including the flying ambulance, the triage system, improvements in amputation procedures, and a new therapeutic outlook on hypothermia. His contributions toward improving military surgery led to both reduced soldier mortality and the utilization of surgical principles that we still use in modern medicine. His efforts earned him the title of “The Father of Modern Military Surgery”.

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.