Delayed esophageal perforation following anterior cervical disc arthroplasty: A case of trauma-induced prosthesis dislocation and hardware failure

Abstract

Background: Anterior cervical disc arthroplasty (ACDA) may rarely result in esophageal perforation. Case Description: A 56-year-old male underwent a C5–c6 ACDA for a cervical disc herniation. Three months postoperatively, trauma led to anterior dislocation of the interbody prosthesis, resulting in the acute onset of dysphagia accompanied by wound drainage. The delayed diagnosis of esophageal perforation was established when the cervical computed tomography documented anterior migration of the screws/plates and an air/fluid level in the surgical field. Despite a multidisciplinary approach, including anterior surgical revision followed by posterior stabilization, the patient became septic and expired. Conclusion: The incidence of esophageal perforation following ACDA ranges from 0.02% to 1.52%, with hardware failure being the leading cause. Prompt recognition and multidisciplinary management are essential for optimizing patient outcomes. Here, trauma-induced prosthesis dislocation warranting circumferential surgery failed to control sepsis, and the patient died. © 2025 Elsevier B.V., All rights reserved.