Multidisciplinary management of thoracic esophageal fistula secondary to traumatic upper thoracic fracture (T3–4) with associated discitis/osteomyelitis and spinal epidural abscess: illustrative case

BACKGROUNDAn esophageal fistula secondary to a traumatic upper thoracic (T3-4) fracture with resultant thoracic discitis/osteomyelitis and an epidural abscess with neurological compromise is a rare clinical entity. Early diagnosis is critical for an optimal clinical outcome avoiding grave and progre...

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Bibliographic Details
Published in:Journal of neurosurgery. Case lessons 2023-09, Vol.6 (10)
Main Authors: Schaible, Peter, Gordon, Paul, Kalimuthu, Ramasamy, Omi, Ellen, Schaible, Keith
Format: Article
Language:English
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Summary:BACKGROUNDAn esophageal fistula secondary to a traumatic upper thoracic (T3-4) fracture with resultant thoracic discitis/osteomyelitis and an epidural abscess with neurological compromise is a rare clinical entity. Early diagnosis is critical for an optimal clinical outcome avoiding grave and progressive spinal dissemination with structural instability and neurological deterioration. OBSERVATIONSThe following case, not clearly described previously in the literature, highlights the clinical course and multidisciplinary approach to management including a single-stage posterior cervicothoracic (C3-T6) decompression with vertebral reconstruction with an expandable interbody cage (T2-4) and posterior cervicothoracic fusion and instrumentation (C3-T6), followed by direct esophageal fistula closure with AlloDerm and a vascularized latissimus dorsi muscle flap. LESSONSEarly diagnosis and the potential treatment of a posttraumatic esophageal fistula requires a multidisciplinary approach.
ISSN:2694-1902
2694-1902
DOI:10.3171/CASE23344