Outcomes of Repair for Delayed Esophageal Perforation after Anterior Cervical Discectomy and Fusion: A Systematic Review and Case Series.

OBJECTIVE

Delayed pharyngoesophageal perforation (DPEP) following anterior cervical discectomy and fusion (ACDF) is an uncommon but life-threatening complication. We aimed to synthesize published reports of delayed PEP following ACDF and present a contemporary institutional case series detailing management strategies and outcomes of esophageal repair.

METHODS

A PRISMA-guided systematic review searched articles that included patients who underwent ACDF and had DPEP. Nine studies (206 screened, 23 full text) met the inclusion criteria, yielding 57 patients with DPEP after ACDF. Separately, we reviewed institutional records of 6 patients treated for DPEP between January 2019 and September 2025.

RESULTS

Our systematic review identified 57 cases of DPEP following ACDF, with a mean age of 52 years and a male predominance (65%). The average time from ACDF to diagnosis of DPEP was 42 months. Perforations most frequently occurred following single-level fusions (44%) and were primarily attributed to hardware-related causes, such as pseudarthrosis (70%). In our institutional case series of 6 patients (mean age 54 years), the median time from ACDF to DPEP repair was 68 months. Pectoralis major flap reconstruction was the most common technique (83%), with a mean postoperative length of stay (LOS) of 9 days.

CONCLUSIONS

ACDF-related DPEP typically manifests months to years after surgery. Combined instrumentation removal with vascularized flap coverage is associated with high rates of durable closure and low mortality. Our contemporary series adds granular operative details and illustrates feasibility of vascularized flap reinforcement in selected patients.