PDF(Pubmed)
Abstract：
Anterior cervical discectomy and fusion (ACDF) represents one of the most commonly performed spine surgeries. Dysphagia secondary to esophageal injury during retraction is one of the most common complications, and usually leads to self-limiting dysphagia. However, actual perforation and violation of the esophageal tissue is much rarer and can lead to delayed deep infections. Prevertebral abscess\' are one of the most feared complications after ACDF, as they can lead to severe tissue swelling, osteomyelitis, hardware failure, and even death. Due to their rarity, a gold standard of workup and treatment is still unknown. A healthy 47-year-old female presents 9 months after a C4-C7 ACDF done at an outside institution with a large prevertebral abscess, osteomyelitis, hardware failure, and pseudoarthrosis secondary to esophagopharyngeal defect and prominent hardware. Overall, the patient underwent eight surgeries, and required an extended course of intravenous (IV) antibiotics, multiple diagnostic procedures, and complex soft tissue coverage using an anterolateral thigh free flap. Currently, the patient is doing well 6 months from her last procedure without any complications or plan for future surgery. This was an extremely rare case of a late occurring prevertebral abscess after ACDF. Dysphagia in the late postoperative setting should be evaluated carefully and thoroughly for any esophageal perforation and deep infection. As exemplified in this case, even partial thickness injuries to the esophageal-pharyngeal anatomy due to hardware irrigation can lead to catastrophic complications over time. Safe removal of all hardware anteriorly to avoid continued irritation of the esophagopharyngeal mucosa should be prioritized. If anterior hardware is necessary for stability, implants with the smallest footprint should be utilized. Early collaboration with ENT colleagues should be a priority and can provide crucial diagnostic and therapeutic interventions. Complex closure with a free flap was shown to be an effective way to provide successful definitive soft tissue coverage.
摘要：
颈椎前路椎间盘切除术和融合术（ACDF）是最常见的脊柱手术之一。食管回缩过程中继发的吞咽困难是最常见的并发症之一，通常会导致自限性吞咽困难。然而,食管组织的实际穿孔和侵犯更罕见，可导致延迟的深部感染。椎前脓肿是ACDF后最令人恐惧的并发症之一，因为它们会导致严重的组织肿胀，骨髓炎,硬件故障,甚至死亡。由于它们的稀有性,检查和治疗的黄金标准仍然未知。一名健康的47岁女性在患有大型椎前脓肿的外部机构进行C4-C7ACDF后9个月出现，骨髓炎,硬件故障,和继发于食道咽缺损和突出硬件的假关节。总的来说,病人接受了八次手术,需要延长疗程的静脉注射（IV）抗生素，多种诊断程序，使用股前外侧游离皮瓣覆盖复杂的软组织。目前,患者在上次手术后6个月表现良好，没有任何并发症或未来手术计划。这是ACDF后晚期发生的椎前脓肿的极为罕见的病例。术后晚期吞咽困难应仔细彻底评估是否有食管穿孔和深部感染。在这种情况下，即使由于硬件冲洗导致的食管-咽解剖结构部分厚度损伤,也会随着时间的推移导致灾难性的并发症.应优先考虑安全去除所有硬件，以避免持续刺激食管咽粘膜。如果前硬件对于稳定性是必要的，应使用占地面积最小的植入物。与ENT同事的早期合作应该是优先事项，可以提供关键的诊断和治疗干预措施。用自由皮瓣进行复杂的闭合被证明是提供成功的最终软组织覆盖的有效方法。
