2025 Clinician Corner - Esophageal perforation following anterior cervical discectomy and fusion

Abstract 

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal surgeries performed in the US but is associated with various morbidities. Esophageal perforation is one of the rarest complications of ACDF, but it is potentially fatal, therefore requiring timely detection and treatment. We present three cases of esophageal perforation after ACDF.

KEYWORDS Anterior cervical discectomy and fusion; case series; postoperative complication; esophageal perforation; hardware complication

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on January 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Identify esophageal perforation as a rare but potentially fatal complication of anterior cervical discectomy and fusion (ACDF). 
  • Recognize the importance of considering this complication in the differential diagnosis of post-ACDF symptoms (e.g., dysphagia, neck/chest pain, hoarseness) to ensure timely management with primary repair and hardware removal. 

Key points 

  • Esophageal perforation is a rare but potentially fatal complication of anterior cervical discectomy and fusion (ACDF) that can be a result of iatrogenic injury or hardware erosion, among other causes.
  • Symptoms of esophageal perforation can range from asymptomatic to dysphagia, neck/chest pain, and hoarseness. Many of these symptoms are also general complaints from patients following ACDF, so it is imperative to consider esophageal perforation in the differential to prevent delayed diagnosis of this serious complication. 
  • While there is no gold standard universal approach to treating esophageal perforation, primary surgical repair and hardware removal is a mainstay of treatment for early and delayed cases.  

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
01/01/2025
Course expires: 
01/01/2026
Cost:
$25.00
Rating: 
0
  • Tarun Sontam, BS - Texas A&M School of Medicine, College Station, Texas, USA 
  • William Hlavinka, BS - Texas A&M School of Medicine, College Station, Texas, USA 
  • Eitan Podgaetz, MD - Department of Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA 
  • Richard Naftalis, MD - Baylor Scott & White Neurosurgery and Spine Associates, Dallas, Texas, USA 
  • Gary S. Schwartz, MD - Department of Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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