Gelfoam-induced Swallowing Difficulty after Anterior Cervical Spine Surgery
A 77-year-old man was presented with neck pain for several months. Cervical lateral radiographics demonstrated a multisegmental anterior osteophyte formation, especially at C 3-4 (). However, he did notcomplain of any respiratory and swallowing difficulties. Therefore, we decided that conservative treatment may be better suited for this case. Five months later, he was admitted to our hospital with swallowing difficulty, which occurred ten days prior to presentation. He could only eat soft foods with frequent coughing. A computed tomography (CT) scan was performed and demonstrated anterior osteophyte with indentation on the esophagus (). Magnetic resonance (MR) images showed multisegmental anteriorly flowing osteophyte formation with esophageal indentation. The videofluoroscopic swallowing study (VFSS) showed abnormal coordination of peristaltic movement and reflux to the trachea on a pharyngeal phase. We recommended tube feeding.\nWe removed the DISH via anterolateral cervical approach and applied gelfoam on the osteophyte removal site, owing to the uneven surface of the remained osteophyte. After the operation, the patient was relieved from the swallowing difficulty and had normal diet, except solid foods. On POD 7, he complained of swallowing difficulty again, but the degree of dysphagia was less than the preoperative state. His vital signs, including respiration, were stable. Cervical lateral radiographics demonstrated air formation on osteophyte removal site (). CT scan demonstrated free air with low density fluid collection on the prevertebral and right paravertebral space and swelling (). On laryngoscopic examination, the perforation and fistula were not noted. Endoscopic examination showed no esophageal perforation. The repeated VFSS showed a decline of laryngeal elevation and disability of laryngeal closure, and recommended small amounts oral feeding. The symptom was not severe and respiratory difficulty was not noted. We closely observed the patient.\nFourteen days later, the swallowing difficulty was relieved and repeated CT scan showed lesser compression to the esophagus, in spite of the free air and swelling that still remain ().\nThree months later, the patient could eat all foods, including solid foods. The radiographic showed no swelling and free air ().