S4376 A Rare Culprit Behind Dysphagia: Esophageal Diverticulum Following Anterior Cervical Discectomy and Fusion

Introduction: Anterior cervical discectomy and fusion (ACDF) is commonly performed for cervical spine disorders and has excellent outcomes. While transient dysphagia is a known and usually short-lived complication, rare delayed issues like esophageal diverticulum can arise. We present a rare case of a patient who developed an esophageal diverticulum following ACDF. Case Description/Methods: A 62-year-old man with a history of type 2 diabetes mellitus and prior cervical spine injury requiring ACDF about 8 months ago presented with 3 day onset of dysphagia to both solids and liquids and odynophagia. He reported pain in the side of his neck during swallowing and a sensation of food getting stuck in his chest. Laboratory studies were normal with no leukocytosis. A computed tomography scan of the neck revealed a 2.8 × 3.7 × 8 cm fluid collection in the prevertebral space extending from C7 to T4. This collection was displacing the esophagus to the right. The C6-C7 spinal hardware appeared intact. He was started on intravenous antibiotics for a suspected abscess or infected cyst. Due to concern for recurrence of a previously resolved esophageal fistula after surgery, a repeat upper endoscopy was performed, revealing a proximal esophageal diverticulum 24 cm from the incisors without narrowing or obstruction. An erythematous area seen above the diverticulum may explain his odynophagia. A barium swallow confirmed no fistula. The patient was started on a liquid diet. Follow-up computed tomography showed near-complete resolution of the fluid collection, with a residual air-filled diverticulum communicating with the esophagus. Intermittent food retention likely caused esophageal pressure and dysphagia, while odynophagia was attributed to mucosal irritation from retained material. He was ultimately able to tolerate a soft diet with viscous lidocaine and was advised to revert to clear liquids if symptoms returned. Due to the risk of recurrence, he was referred to a higher-level center for surgical evaluation. Discussion: ACDF is generally a safe and reliable procedure, but complications can still happen. The most common is difficulty swallowing present in 2% to 67% of cases, and it usually improves with time. When it doesn’t, less typical causes like esophageal diverticulum—seen in about 1.6% of patients—should be considered. This can be linked to scarring or pressure from implanted hardware. If infection is present or the hardware is exposed, surgery may be needed. Early detection of these complications often leads to better patient comfort and smoother recovery.