Dysphagia following cervical fusion.

A 68-year-old man sought evaluation for a 5-year history of dysphagia, which had begun following surgical repair and fixation of the C6 and C7 vertebrae. Endotracheal intubation prior to the spinal surgery was made difficult by the presence of the patient's cervical halo. As a result of either the difficult intubation or the surgery itself, he sustained an esophageal perforation. The perforation had been managed conservatively with parenteral nutrition and a nothing-by-mouth order for 3 weeks. When the patient resumed his diet, he complained of immediate dysphagia when taking all consistencies of food. The dysphagia was manifested by frequent regurgitation and choking. A barium swallow examination detected a diverticulum.

The patient had ignored the diverticulum for 5 years. When he finally presented to us for definitive management, we performed in-office transnasal esophagoscopy, which revealed the presence of a moderate pouch-like laxity of the lumen just distal to the level of the cricoid cartilage. Along the posterior wall of the esophagus, we noted an area of frank mucosal erosion around the head of a screw (figure). The appearance of the remainder of the esophagus was normal. Surgical intervention was planned to remove the hardware and to repair the esophageal perforation.

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From the Emory Voice Center, Department of Otolaryngology--Head and Neck Surgery, Emory University, Atlanta.