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Pediatric Rehabilitation

Delayed Diagnosis of Esophageal Perforation Following Anterior Cervical Discectomy and Fusion in a Pediatric Patient

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater

    Primary Author(s)

  • TF

    Taylor Fedor

    Medical Student
    Albany Medical College
    Albany, New York

    • Co-Author(s)

  • Kendall Prowse, DO

    Attending Physician
    Penn State Milton S. Hershey Medical Center
    Hershey, Pennsylvania

  • SH

    Sara Huss, MD

    Division Chief and Residency Program Director
    Albany Medical Center PM&R Program
    Albany, New York

    • Poster Presenter(s)

  • Lee Esposito, DO

    Resident/House Staff
    Albany Medical Center PM&R Residency
    Clifton Park, New York

Disclosure(s):
Kendall Prowse, DO: No financial relationships to disclose
Lee Esposito, DO: No financial relationships to disclose
Case Diagnosis: A 16-year-old boy with tetraplegia following motor vehicle accident who developed esophageal perforation following anterior cervical hardware placement.

Case Description or Program Description: A 16-year-old male presented to the ED following a motor vehicle accident, sustaining cervical fractures with immediate tetraplegia. He underwent anterior cervical discectomy and fusion (ACDF) with posterior fusion from C4 to C7 and a gastrostomy tube (PEG) placement. His hospital stay was prolonged due to respiratory complications. Four months post-injury, he was transferred to a long-term care facility but was readmitted within a week for hypoxia and dysphagia, suspected to be due to a tracheotomy infection.
Due to persistent dysphagia, a fluoroscopic modified barium swallow study was performed and initially reported as normal. However, a subsequent review by the physiatry team identified contrast accumulation outside the esophageal trajectory. Computed Tomography (CT) imaging confirmed an esophageal perforation with mediastinal contrast leakage. The patient was placed on NPO status, and multiple surgical teams were consulted.

Setting: Tertiary Care Center

Assessment/Results: On hospital day 12, endoscopy revealed exposed spinal hardware in the proximal esophagus with purulence, suggesting chronicity. Neurosurgery removed the anterior cervical hardware, replacing it with a cage, and performed a C5-C6 decompression. Otolaryngology and thoracic surgery conducted multiple washouts and debridement. Initial attempts at esophageal closure with a sternocleidomastoid flap failed, necessitating a pectoralis muscle flap for definitive closure. The hardware erosion was identified as a postoperative complication of ACDF.

Discussion (relevance): Esophageal perforation is a rare complication of ACDF and can be difficult to detect, especially in patients with alternative feeding methods like a PEG tube, which may mask typical symptoms and instead present with atypical respiratory illness, as seen in this case.

Conclusions: Delayed esophageal perforation after cervical spine surgery can present with subtle or atypical signs, requiring high clinical vigilance and a multidisciplinary approach for early detection and effective management.