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Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3):179-183. doi: 10.1016/j.anorl.2019.03.004. Epub 2019 Mar 21.

Spondylodiscitis after transoral robotic surgery: Retrospective 7-case series from the GETTEC group.

Author information

1
Service d'ORL et chirurgie cervico-faciale, CHU Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France.
2
Service d'ORL et chirurgie cervico-faciale, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
3
Service d'ORL et chirurgie cervico-faciale, CHU Carémeau, place du Pr.-Robert-Debré, 30029 Nîmes cedex 9, France.
4
Service d'ORL et chirurgie cervico-faciale, CHU Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
5
Service d'ORL et chirurgie cervico-faciale, Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
6
Service d'ORL et chirurgie cervico-faciale, Institut de Cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
7
Service d'ORL et chirurgie cervico-faciale, CHU Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France. Electronic address: sylvain.moriniere@univ-tours.fr.

Abstract

BACKGROUND:

Cervical spondylodiscitis is a rare but severe complication of pharyngeal surgery.

MATERIAL AND METHODS:

This multicenter retrospective study reported all patients in the database of the French head and neck tumor study group (GETTEC) affected by cervical spondylodiscitis after transoral robotic surgery (TORS) for malignant pharyngeal tumor from January 2010 to January 2017.

OBJECTIVES:

To describe cases of post-TORS cervical spondylodiscitis, identify alarm signs, and determine optimal management of these potentially lethal complications.

RESULTS:

Seven patients from 6 centers were included. Carcinomas were located in the posterior pharyngeal wall. Tumor stage was T1 or T2. All patients had risk factors for spondylodiscitis. Mean time to diagnosis was 12.6days. The interval between surgery and spondylodiscitis diagnosis ranged from 20days to 4.5months, for a mean 2.1months. The most common symptom was neck pain (87%). Infections were polymicrobial; micro-organisms were isolated in 5 cases and managed by intravenous antibiotics, associated to medullary decompression surgery in 3 cases. Follow-up found favorable progression in 4 cases, and 3 deaths (mortality, 43%).

CONCLUSION:

This French multicenter study found elevated mortality in post-TORS spondylodiscitis, even in case of limited resection. Surgeons must be aware of this complication and alerted by persistent neck pain, fever, asthenia, impaired or delayed posterior pharyngeal wall wound healing or elevation of inflammatory markers. MRI is the most effective diagnostic radiological examination.

KEYWORDS:

Cervical spondylodiscitis; Pharyngeal tumor; Robotic surgery; Spondylodiscitis; TORS; Transoral robotic surgery

PMID:
30905532
DOI:
10.1016/j.anorl.2019.03.004
[Indexed for MEDLINE]

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