Pharyngovertebrale Fistel mit transspinalem Verlauf zur Nackenhaut bei zervikaler Spondylodese – Falldarstellung und Literaturübersicht

 

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Zusammenfassung

Hintergrund: Pharyngovertebrale Fisteln – insbesondere mit zeitlich verzögerter Diagnosestellung – sind eine sehr seltene, aber schwerwiegende Komplikation bei Halswirbelsäuleneingriffen. Patienten und Methoden: Dargestellt wird der Fall eines postoperativ aus Italien übernommenen Patienten, der infolge eines Implantat-Infekts eine pharyngovertebrale Fistel mit transspinalem Verlauf zur dorsalen Nackenhaut entwickelte. Falldarstellung: Bei dem präsentierten Patienten gelang bei pharyngovertebraler Fistel mit transspinaler Ausdehnung nach mehrfachen Revisionen der Verschluss der Fistel im ventralen Anteil mit einem Platysma-Lappen und im dorsalen Anteil über eine Drainage. Literaturüberblick: Anhand einer ausführlichen Literaturrecherche erfolgt die Darstellung von Ätiologie, Diagnostik und Behandlung von pharyngovertebralen Fisteln. Schlussfolgerung: Die dargestellte pharyngovertebrale Fistel mit transspinalem Verlauf zur dorsalen Nackenhaut stellt nach Kenntnis der Autoren eine bis dato nicht veröffentlichte Komplikation eines ventralen Halswirbelsäuleneingriffs dar.

Abstract

Background: Pharyngo-vertebral fistulas – especially with delayed diagnosis – are a rare but grave reported complication in cervical spine surgery. Patients and Methods: We present a patient, sent postoperatively from Italy after cervical spine surgery to our department. The patient has developed a pharyngo-vertebral fistula with transspinous course to the dorsal neck skin due to infected spondylodesis. Case Report: In the presented patient, the successful closure of the pharyngo-vertebral fistula with transspinous course was made after diverse revisions at the anterior side with a platysma flap, at the posterior one with a drain. Review of the Literature: Aetiology, diagnostic work-up and treatment opinions are discussed in a detailed literature review. Conclusion: To the best of the authors' knowledge the presented pharyngo-vertebral fistula with transspinous course to the dorsal neck skin as a complication after anterior cervical spine surgery has not been reported in the literature before.

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Dr. Andreas Badke

Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen
Berufsgenossenschaftliche Unfallklinik Tübingen

Schnarrenbergstraße 95

72076 Tübingen

Phone: 0 70 71/6 06-38 91

Fax: 0 70 71/6 06-10 24

Email: bulmar@bgu-tuebingen.de