Heterogeneous Presentations of Pharyngoesophageal Diverticula Occurring after Cervical Spine Surgery
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ORIGINAL ARTICLE
Heterogeneous Presentations of Pharyngoesophageal Diverticula Occurring after Cervical Spine Surgery Pranati Pillutla1 · Kevin O. Juarez2 · Alden Smith3 · Jennifer L. Long3,4 · Dinesh K. Chhetri3 Received: 1 July 2020 / Accepted: 24 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Dysphagia after anterior cervical spine surgery (ACSS) may be secondary to pharyngoesophageal diverticulum. Our objectives are to (1) highlight the heterogeneity in clinical presentation, (2) discuss pathophysiology and management, and (3) present a comprehensive literature review of these diverticula. All patients undergoing pharyngoesophageal diverticulum repair between 2013 and 2019 were identified. Cases with ACSS history underwent detailed review of clinical presentation, assessment, and management. Literature review and analysis of all reported ACSS-associated pharyngoesophageal diverticula was performed. Two hundred forty-three cases of pharyngoesophageal diverticulum repair were performed during the study period; 13 cases were ACSS-associated. Four types of clinical presentation were identified: (Type A) Spinal hardware present, with videofluoroscopic evidence of exposed hardware; (Type B) Spinal hardware present, without videofluoroscopic evidence of exposed hardware; (Type C) Spinal hardware absent due to prior spinal hardware removal or ACSS performed without hardware; and (Type D) Concurrent esophago-esophageal fistula (EEF) present. All of our cases were evaluated using modified barium swallow study and esophagoscopy and definitively managed with endoscopic diverticulotomy. Literature review identified 21 cases of ACSS-associated pharyngoesophageal diverticulum repair from 18 publications. The majority of cases were identified using barium esophagram (N = 18, 86%) and managed with open diverticulectomy (N = 19, 90%). There were no reports of EEF. ACSS-associated pharyngoesophageal diverticulum must be evaluated with fluoroscopy and endoscopy, which determine presentation type. Presentation type guides management. Esophageal perforation requires hardware removal and perforation repair with flap placement. Endoscopic diverticulotomy was found essential to definitive management. Level of Evidence: 4 Keywords Dysphagia · Pharyngoesophageal diverticulum · Anterior cervical spine surgery · Spine hardware · Endoscopic diverticulotomy
Introduction
* Dinesh K. Chhetri [email protected] 1
School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
2
Yale School of Medicine, New Haven, CT, USA
3
Department of Head and Neck Surgery, UCLA Medical Center, 62‑132 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
4
Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
Dysphagia after anterior cervical spine surgery (ACSS) varies in degree and duration [1]. Evaluation of ACSSassociated dysphagia often includes radiographic studies. These studies may reveal a pharyngoesophageal (PE) diverticulum that appears radiographi
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