Esophageal squamous cell carcinoma in a patient with spinal cord injury complicated by achalasia: a case report

The progression from spinal cord injury(SCI) to secondary achalasia and subsequent esophageal squamous cell carcinoma (ESCC) is exceptionally rare. We report the case of a 51-year-old female who developed progressive dysphagia seven years after a T6-level spinal injury. Barium swallow and endoscopic examinations revealed the classic "bird's beak sign" and a suspicious esophageal lesion. Given the patient's paraplegic condition and associated anesthetic risks, endoscopic intervention was contraindicated. Following evaluation by a multidisciplinary team, a combined thoracoscopic-laparoscopic esophagectomy with cervical anastomosis, lymph node dissection, and pyloroplasty was performed. Postoperative pathology confirmed ESCC (pT2N0M0, Stage IIB). This case suggests a potential pathological sequence of "SCI → achalasia → ESCC": SCI may induce or exacerbate achalasia through neurogenic mechanisms, while prolonged esophageal stasis likely elevates the risk of malignant transformation. Additionally, symptom masking due to paraplegia and procedural challenges often contribute to diagnostic delays, adversely affecting prognosis. This report highlights the need for individualized surveillance protocols and multidisciplinary intervention pathways in SCI patients with long-standing achalasia to improve clinical outcomes.