背景:咽食管憩室是颈前路椎间盘切除和融合术后罕见的并发症。
方法:我们的患者是一名48岁的女性,先前进行了两次颈椎手术,其中C4-C5和C5-C6固定,最后一次是在2003年。手术两年后,她表现出关节痛,关节炎,发冷,和起伏不定的皮疹。2007年,她出现吞咽困难,口臭,和痰液生产。她被诊断患有咽食管憩室,并伴有C6椎骨瘘和继发性脊柱炎。她被带去了开放性手术,取出了螺钉和钢板,环咽肌切开术,和食道修复。米氏链球菌在组织和骨合成材料中生长。她接受了4个月的阿莫西林和丙磺舒治疗,并完全康复。自1991年以来,报告了19例类似病例,其中1例死亡。据我们所知,这是首例憩室并发瘘管和继发性脊柱炎的病例。
结论:在有颈前路椎间盘切除术和融合抱怨吞咽困难的患者中,甚至在手术多年后,必须进行食管造影。在文献报道的病例中,有88%提到了这种症状。
BACKGROUND: Pharyngoesophageal diverticulum is an uncommon complication after anterior cervical discectomy and fusion surgery.
METHODS: Our patient was a 48-year-old woman with two previous cervical surgeries with fixation of C4-C5 and C5-C6, the last one in 2003. Two years after surgery, she presented with arthralgia, arthritis, chills, and fluctuating rash. In 2007, she presented with dysphagia, halitosis, and sputum production. She was diagnosed with a pharyngoesophageal diverticulum with a fistula to C6 vertebra and secondary spondylitis. She was taken for open surgery with removal of screws and plates, cricopharyngeal myotomy, and esophageal repair. Streptococcus milleri grew in tissue and osteosynthetic material. She received 4 months of amoxicillin and probenecid and had a complete recovery. Since 1991, 19 similar cases have been reported with one fatality. To our knowledge, this is the first reported
case of diverticulum complicated with fistula and secondary spondylitis.
CONCLUSIONS: In patients with a history of anterior cervical discectomy and fusion complaining of dysphagia, even years after surgery, it is mandatory to perform an esophagogram. This symptom was referred to in 88% of the cases reported in the literature.