{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T02:14:13Z","timestamp":1780107253118,"version":"3.54.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,14]]},"abstract":"\n BACKGROUND<\/jats:title>\n Esophageal perforation is a rare but deadly complication of cervical spine fractures. Early identification can be difficult but is imperative for proper treatment and prevention of life-threatening infection. Once diagnosed, surgical drainage and broad-spectrum antibiotics can yield positive outcomes. The authors present a successfully managed case of cervical spine fracture with associated esophageal perforation and necrotizing fasciitis as well as an extensive literature review.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n An 87-year-old male with a previous cervical laminectomy presented to the emergency department with shortness of breath after a ground-level fall. Initial CT imaging of the cervical spine was noted to have no abnormalities at the time, and the patient was sent home. Eight days later, he presented again with neck pain, spasm, overt hyperextension injury, and fracture of the C7 vertebra, which was seen on CT. Initial surgical fixation was aborted due to the discovery of necrotizing fasciitis resulting from esophageal perforation. After surgical repair, debridement, and antibiotics, the fracture was stabilized via C2\u2013T3 posterior segmental instrumented fusion. Following a complex hospital course, the patient was ultimately discharged following inpatient rehabilitation at his neurological baseline.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Esophageal perforation and necrotizing fasciitis from cervical spine injuries can be deadly if not diagnosed and managed early. A high level of suspicion should be maintained with disruption of the anterior column of the cervical spine. A combination of surgical and medical management can yield successful treatment.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24720<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24720","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T20:16:26Z","timestamp":1744661786000},"source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis and management of esophageal perforation with necrotizing fasciitis in traumatic cervical spine injuries: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Arman","family":"Kavoussi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Ricciardelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7779-7519","authenticated-orcid":true,"given":"Alexander","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson Eddie","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander E.","family":"Ropper","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2365-587X","authenticated-orcid":true,"given":"Cyrus","family":"King","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"World Neurosurg","first-page":"e427","article-title":"Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013","volume":"110","author":"Passias","year":"2018","unstructured":"Passias PGPoorman GWSegreto FATraumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg. 2018;110:e427-e437."},{"issue":"19","key":"bib2","series-title":"Spine","first-page":"1532","article-title":"The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center","volume":"36","author":"Miller","year":"2011","unstructured":"Miller CPBrubacher JWBiswas DLawrence BDWhang PGGrauer JN.The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center. Spine. 2011;36(19):1532-1540."},{"issue":"6","key":"bib3","series-title":"J Spinal Disord Tech","first-page":"513","article-title":"Esophageal perforation after fracture of the cervical spine: case report and review of the literature","volume":"15","author":"N\u00e9rot","year":"2002","unstructured":"N\u00e9rot CJeanneret BLardenois TL\u00e9pous\u00e9 C.Esophageal perforation after fracture of the cervical spine: case report and review of the literature. J Spinal Disord Tech. 2002;15(6):513-518."},{"issue":"12","key":"bib4","series-title":"Paraplegia","first-page":"903","article-title":"Oesophageal trauma in patients with spinal cord injury","volume":"30","author":"English","year":"1992","unstructured":"English GMHsu SFEdgar RGibson-Eccles M.Oesophageal trauma in patients with spinal cord injury. Paraplegia. 1992;30(12):903-912."},{"issue":"5S","key":"bib5","series-title":"J Am Coll Radiol","first-page":"S104","article-title":"ACR Appropriateness Criteria\u00ae Dysphagia","volume":"16","author":"Levy","year":"2019","unstructured":"Levy ADCarucci LRACR Appropriateness Criteria\u00ae Dysphagia. J Am Coll Radiol. 2019;16(5S):S104-S115."},{"issue":"5","key":"bib6","series-title":"AJR Am J Roentgenol","first-page":"1177","article-title":"Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture","volume":"182","author":"Fadoo","year":"2004","unstructured":"Fadoo FRuiz DEDawn SKWebb WRGotway MB.Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture. AJR Am J Roentgenol. 2004;182(5):1177-1179."},{"issue":"5","key":"bib7","series-title":"Ann Surg","first-page":"701","article-title":"Esophageal perforation diagnosis and treatment","volume":"161","author":"Foster","year":"1965","unstructured":"Foster JHJolly PCSawyers JLDaniel RA.Esophageal perforation diagnosis and treatment. Ann Surg. 1965;161(5):701-709."},{"key":"bib8","series-title":"BMJ","first-page":"n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","unstructured":"Page MJMcKenzie JEBossuyt PMThe PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71."},{"issue":"8","key":"bib9","series-title":"Am Surg","first-page":"915","article-title":"Esophageal injury from cervical spine fracture in blunt trauma","volume":"76","author":"Fahr","year":"2010","unstructured":"Fahr METhomas BWBarker DE.Esophageal injury from cervical spine fracture in blunt trauma. Am Surg. 2010;76(8):915-916."},{"issue":"22","key":"bib10","series-title":"Spine","first-page":"E1364","article-title":"Esophageal perforation in a cervical fracture patient with progressed ankylosing spondylitis: case report and review of the literature","volume":"41","author":"Wang","year":"2016","unstructured":"Wang JShi LChen HYuan W.Esophageal perforation in a cervical fracture patient with progressed ankylosing spondylitis: case report and review of the literature. Spine. 2016;41(22):E1364-E1367."},{"issue":"6","key":"bib11","series-title":"J Neurosurg Spine","first-page":"709","article-title":"Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders","volume":"27","author":"Teunissen","year":"2017","unstructured":"Teunissen FRVerbeek BMCha TDSchwab JH.Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg Spine. 2017;27(6):709-716."},{"issue":"1","key":"bib12","series-title":"J Int Med Res","first-page":"170","article-title":"Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: two case reports and literature review","volume":"44","author":"Qian","year":"2016","unstructured":"Qian SJYe XSChen WSLi WL.Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: two case reports and literature review. J Int Med Res. 2016;44(1):170-175."},{"issue":"5","key":"bib13","series-title":"Orthop Traumatol Surg Res","first-page":"543","article-title":"Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases","volume":"98","author":"Kouyoumdjian","year":"2012","unstructured":"Kouyoumdjian PGuerin PSchaelderle CAsencio GGille O.Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases. Orthop Traumatol Surg Res. 2012;98(5):543-551."},{"issue":"5","key":"bib14","series-title":"J Natl Med Assoc","first-page":"473","article-title":"Rupture of cervical esophagus from blunt trauma with concomitant fracture dislocation of C4-C5 vertebrae","volume":"71","author":"Makoyo","year":"1979","unstructured":"Makoyo PZ.Rupture of cervical esophagus from blunt trauma with concomitant fracture dislocation of C4-C5 vertebrae. J Natl Med Assoc. 1979;71(5):473-474."},{"issue":"4 Pt 1","key":"bib15","series-title":"Ann Otol Rhinol Laryngol","first-page":"323","article-title":"Esophageal and hypopharyngeal injuries in patients with cervical spine trauma","volume":"90","author":"Pollock","year":"1981","unstructured":"Pollock RAPurvis JMApple DFMurray HH.Esophageal and hypopharyngeal injuries in patients with cervical spine trauma. Ann Otol Rhinol Laryngol. 1981;90(4 Pt 1):323-327."},{"issue":"1","key":"bib16","series-title":"BMC Musculoskelet Disord","first-page":"677","article-title":"Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome\u2014a case report and literature review","volume":"21","author":"Li","year":"2020","unstructured":"Li XWang FZhang JHong YYang Y.Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome\u2014a case report and literature review. BMC Musculoskelet Disord. 2020;21(1):677."},{"issue":"4","key":"bib17","series-title":"Neurosurgery","first-page":"492","article-title":"Occult esophageal perforation associated with cervical spine fracture","volume":"14","author":"Tomaszek","year":"1984","unstructured":"Tomaszek DERosner MJ.Occult esophageal perforation associated with cervical spine fracture. Neurosurgery. 1984;14(4):492-494."},{"issue":"653","key":"bib18","series-title":"Br J Radiol","first-page":"369","article-title":"Oesophageal perforation with fracture dislocation of cervical spine due to hyperextension injury","volume":"55","author":"Agha","year":"1982","unstructured":"Agha FPRaji MR.Oesophageal perforation with fracture dislocation of cervical spine due to hyperextension injury. Br J Radiol. 1982;55(653):369-372."},{"key":"bib1","series-title":"World Neurosurg","first-page":"e427","article-title":"Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013","volume":"110","author":"Passias","year":"2018","unstructured":"Passias PGPoorman GWSegreto FATraumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg. 2018;110:e427-e437."},{"issue":"19","key":"bib2","series-title":"Spine","first-page":"1532","article-title":"The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center","volume":"36","author":"Miller","year":"2011","unstructured":"Miller CPBrubacher JWBiswas DLawrence BDWhang PGGrauer JN.The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center. Spine. 2011;36(19):1532-1540."},{"issue":"6","key":"bib3","series-title":"J Spinal Disord Tech","first-page":"513","article-title":"Esophageal perforation after fracture of the cervical spine: case report and review of the literature","volume":"15","author":"N\u00e9rot","year":"2002","unstructured":"N\u00e9rot CJeanneret BLardenois TL\u00e9pous\u00e9 C.Esophageal perforation after fracture of the cervical spine: case report and review of the literature. J Spinal Disord Tech. 2002;15(6):513-518."},{"issue":"12","key":"bib4","series-title":"Paraplegia","first-page":"903","article-title":"Oesophageal trauma in patients with spinal cord injury","volume":"30","author":"English","year":"1992","unstructured":"English GMHsu SFEdgar RGibson-Eccles M.Oesophageal trauma in patients with spinal cord injury. Paraplegia. 1992;30(12):903-912."},{"issue":"5S","key":"bib5","series-title":"J Am Coll Radiol","first-page":"S104","article-title":"ACR Appropriateness Criteria\u00ae Dysphagia","volume":"16","author":"Levy","year":"2019","unstructured":"Levy ADCarucci LRACR Appropriateness Criteria\u00ae Dysphagia. J Am Coll Radiol. 2019;16(5S):S104-S115."},{"issue":"5","key":"bib6","series-title":"AJR Am J Roentgenol","first-page":"1177","article-title":"Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture","volume":"182","author":"Fadoo","year":"2004","unstructured":"Fadoo FRuiz DEDawn SKWebb WRGotway MB.Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture. AJR Am J Roentgenol. 2004;182(5):1177-1179."},{"issue":"5","key":"bib7","series-title":"Ann Surg","first-page":"701","article-title":"Esophageal perforation diagnosis and treatment","volume":"161","author":"Foster","year":"1965","unstructured":"Foster JHJolly PCSawyers JLDaniel RA.Esophageal perforation diagnosis and treatment. Ann Surg. 1965;161(5):701-709."},{"key":"bib8","series-title":"BMJ","first-page":"n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","unstructured":"Page MJMcKenzie JEBossuyt PMThe PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71."},{"issue":"8","key":"bib9","series-title":"Am Surg","first-page":"915","article-title":"Esophageal injury from cervical spine fracture in blunt trauma","volume":"76","author":"Fahr","year":"2010","unstructured":"Fahr METhomas BWBarker DE.Esophageal injury from cervical spine fracture in blunt trauma. Am Surg. 2010;76(8):915-916."},{"issue":"22","key":"bib10","series-title":"Spine","first-page":"E1364","article-title":"Esophageal perforation in a cervical fracture patient with progressed ankylosing spondylitis: case report and review of the literature","volume":"41","author":"Wang","year":"2016","unstructured":"Wang JShi LChen HYuan W.Esophageal perforation in a cervical fracture patient with progressed ankylosing spondylitis: case report and review of the literature. Spine. 2016;41(22):E1364-E1367."},{"issue":"6","key":"bib11","series-title":"J Neurosurg Spine","first-page":"709","article-title":"Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders","volume":"27","author":"Teunissen","year":"2017","unstructured":"Teunissen FRVerbeek BMCha TDSchwab JH.Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg Spine. 2017;27(6):709-716."},{"issue":"1","key":"bib12","series-title":"J Int Med Res","first-page":"170","article-title":"Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: two case reports and literature review","volume":"44","author":"Qian","year":"2016","unstructured":"Qian SJYe XSChen WSLi WL.Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: two case reports and literature review. J Int Med Res. 2016;44(1):170-175."},{"issue":"5","key":"bib13","series-title":"Orthop Traumatol Surg Res","first-page":"543","article-title":"Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases","volume":"98","author":"Kouyoumdjian","year":"2012","unstructured":"Kouyoumdjian PGuerin PSchaelderle CAsencio GGille O.Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases. Orthop Traumatol Surg Res. 2012;98(5):543-551."},{"issue":"5","key":"bib14","series-title":"J Natl Med Assoc","first-page":"473","article-title":"Rupture of cervical esophagus from blunt trauma with concomitant fracture dislocation of C4-C5 vertebrae","volume":"71","author":"Makoyo","year":"1979","unstructured":"Makoyo PZ.Rupture of cervical esophagus from blunt trauma with concomitant fracture dislocation of C4-C5 vertebrae. J Natl Med Assoc. 1979;71(5):473-474."},{"issue":"4 Pt 1","key":"bib15","series-title":"Ann Otol Rhinol Laryngol","first-page":"323","article-title":"Esophageal and hypopharyngeal injuries in patients with cervical spine trauma","volume":"90","author":"Pollock","year":"1981","unstructured":"Pollock RAPurvis JMApple DFMurray HH.Esophageal and hypopharyngeal injuries in patients with cervical spine trauma. Ann Otol Rhinol Laryngol. 1981;90(4 Pt 1):323-327."},{"issue":"1","key":"bib16","series-title":"BMC Musculoskelet Disord","first-page":"677","article-title":"Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome\u2014a case report and literature review","volume":"21","author":"Li","year":"2020","unstructured":"Li XWang FZhang JHong YYang Y.Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome\u2014a case report and literature review. BMC Musculoskelet Disord. 2020;21(1):677."},{"issue":"4","key":"bib17","series-title":"Neurosurgery","first-page":"492","article-title":"Occult esophageal perforation associated with cervical spine fracture","volume":"14","author":"Tomaszek","year":"1984","unstructured":"Tomaszek DERosner MJ.Occult esophageal perforation associated with cervical spine fracture. Neurosurgery. 1984;14(4):492-494."},{"issue":"653","key":"bib18","series-title":"Br J Radiol","first-page":"369","article-title":"Oesophageal perforation with fracture dislocation of cervical spine due to hyperextension injury","volume":"55","author":"Agha","year":"1982","unstructured":"Agha FPRaji MR.Oesophageal perforation with fracture dislocation of cervical spine due to hyperextension injury. Br J Radiol. 1982;55(653):369-372."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24720.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24720.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24720.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:40:19Z","timestamp":1770075619000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24720.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":36,"journal-issue":{"issue":"15"},"URL":"https:\/\/doi.org\/10.3171\/case24720","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}