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Vol. 35. Issue 6.
Pages 334-339 (November - December 2024)
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Vol. 35. Issue 6.
Pages 334-339 (November - December 2024)
Case Report
Cervical spine spondylodiscitis due to neglected esophageal perforation after a dilation procedure 30 years after a laringectomy and radiotherapy. Report of a case and review of literature
Espondilodiscitis del raquis cervical debida a perforación esofágica tras una dilatación esofágica 30 años después de una laringectomía y radioterapia. Reporte de un caso y revisión de la literatura
Caribay Vargas-Reveróna, Ernesto Muñoz-Mahamuda,b, Alex Sorianoc,d,e, Andrés Combaliaa,b,d,e,
Corresponding author
combalia@ub.edu

Corresponding author.
a Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain
b Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
c Department of Infectious Diseases, Bone and Joint Infection Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
d Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
e Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
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Table 1. Reported cases of cervical spondylodyscitis or epidural abscess related to esophageal dilations.
Abstract

Current treatment of cervical spine spondylodiscitis generally involves a radical surgical debridement and stable reconstruction together with antibiotic therapy until complete healing. But this classical approach could be difficult for patients who have been treated previously for an esophageal carcinoma and received radiotherapy.

We present a case of a 75-year-old male who underwent an esophageal dilation procedure and developed afterward a spondylodiscitis with epidural abscess due to a neglected esophageal perforation. Blood cultures were positive for Peptostreptococcus. Cervical spondylodiscitis and epidural abscess are extremely rare complications of esophageal dilations. Successful treatment without debridement was achieved by performing a posterior fixation without decompression associated with antibiotic therapy for 8 weeks. The present case highlights that spondylodiscitis and epidural abscess may be treated in selected cases where the anterior neck is unapproachable and with a recognized pathogen by a posterior approach fixation without debridement, in association to specific antibiotic therapy.

Keywords:
Cervical spine spondylodiscitis
Esophageal perforation
Epidural abscess
Resumen

El tratamiento actual de la espondilodiscitis de la columna cervical implica generalmente un desbridamiento quirúrgico radical y una reconstrucción estable junto con un tratamiento antibiótico hasta la curación completa. Pero este enfoque clásico puede resultar difícil para pacientes que han sido tratados previamente por un carcinoma de esófago y han recibido radioterapia.

Presentamos el caso de un varón de 75 años a quien se le realizó un procedimiento de dilatación esofágica y posteriormente desarrolló una espondilodiscitis con absceso epidural debido a una perforación esofágica desapercibida. Los hemocultivos fueron positivos para Peptostreptococcus. La espondilodiscitis cervical y el absceso epidural son complicaciones extremadamente raras de las dilataciones esofágicas. El tratamiento exitoso sin desbridamiento se logró mediante la realización de una fijación posterior sin descompresión asociada a terapia con antibióticos durante 8 semanas. El presente caso destaca que la espondilodiscitis y el absceso epidural pueden tratarse en casos seleccionados donde la región cervical anterior es inaccesible y con un patógeno reconocido mediante una fijación posterior sin desbridamiento ni descompresión, asociado a una terapia antibiótica específica.

Palabras clave:
Espondilodiscitis raquis cervical
Perforación esofágica
Abceso epidural

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