Heterogeneous Presentations of Pharyngoesophageal Diverticula Occurring after Cervical Spine Surgery.
Pranati Pillutla, Kevin O Juarez, Alden Smith and 2 others
PMID 32885301WHAT IT FOUND
In 13 patients with swallowing difficulty after cervical spine surgery, diverticula often hid exposed hardware or perforation.
A staged approach removing hardware and repairing the defect, followed by endoscopic cutting of the pouch wall, resolved dysphagia in all cases.
Key findings
01Pharyngoesophageal diverticula appearing after anterior cervical spine surgery frequently mask esophageal perforation with exposed hardware, requiring endoscopic evaluation to confirm.
02A two-stage management strategy involving hardware removal, perforation repair, and subsequent endoscopic diverticulotomy successfully resolved dysphagia in all 13 reported cases.
03Esophago-esophageal fistulas originating from these diverticula were asymptomatic and managed by observation rather than surgical repair.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a case series of only 13 patients, which limits the generalizability of the findings. The study is retrospective and single-institution. There is no control group or comparison to standard care. Patients with ACSS history who had perforations but no diverticula were excluded, potentially biasing the presentation types observed.
Declared interests
The authors declare that they have no conflict of interest.
The easy way to misread this
Do not assume that a diverticulum seen on a barium swallow in a patient with cervical spine hardware is a standard Zenker's diverticulum. Treating it as such with endoscopic cutting alone can be dangerous if the hardware is exposed and the esophagus is perforated, which requires open surgical repair first.