Abstract
Abstract
Background
The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis.
Case presentation
A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2–4 had complete osseous fusion without sequestrum.
Conclusion
Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation.
Funder
Medical Research Project of Xi'an Science and Technology Bureau
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Rheumatology
Reference25 articles.
1. Wang B, Kong L, Zhu Z, Gao W, Guo H, Wang X, Li H, Zhao Q, Zhang H, Hao D. Recurrent complex spinal tuberculosis accompanied by sinus tract formation: causes of recurrence and clinical treatments. Sci Rep. 2018;8(1):6933.
2. Wang B, Shang R, Yang T, Zhang H, Hu H, Hu W, Hao D. Evaluation of clinical outcomes of one-stage anterior and posterior surgical treatment for atlantoaxial tuberculosis complicated with neurological damage. BMC Musculoskelet Disord. 2019;20(1):148.
3. Zeng H, Zhang Y, Shen X, Luo C, Xu Z, Liu Z, Liu X, Wang X. Staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess. Int J Clin Exp Med. 2015;8(10):18383–90.
4. Srivastava SK, Aggarwal RA, Bhosale SK, Roy K, Nemade PS. The versatile approach: a novel single incision combined with anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine. Asian Spine J. 2017;11(2):294–304.
5. Sariyilmaz K, Ozkunt O, Sungur M, Dikici F, Domanic U. Esophageal perforation caused by a posterior pedicle screw: a case report. J Pediatr Orthop. 2017;37(2):98–101.
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献