Revision surgery with fibular strut graft and anterior cervical discectomy and fusion plates: a salvage strategy in post–anterior cervical corpectomy and fusion–related delayed esophageal perforation. Illustrative case

BACKGROUND: Delayed pharyngoesophageal perforation (DPEP) after anterior cervical discectomy and fusion (ACDF) is rare but morbid, typically resulting from hardware erosion or migration. When extensive prior constructs limit complete removal, reconstruction that restores anterior column integrity while minimizing recurrent esophageal irritation is needed. OBSERVATIONS: A 24-year-old man with a prior C5-6 corpectomy and C4-7 anterior fusion plus C2-T1 posterior fusion presented 68 months post-ACDF with progressive neck swelling and odynophagia. Imaging and endoscopy confirmed a 4-cm full-thickness perforation with hardware exposed. Furthermore, the anterior plate and failed corpectomy cage were removed, and a fibular strut allograft was fashioned. Two short anterior cervical plates were sutured to the graft's ends and then attached to C4 and C7 vertebral bodies to reconstitute anterior column stability. The esophageal defect was primarily closed with a pectoralis major muscle flap. At the 6-month follow-up, he reported no dysphagia; upright radiographs and CT scans demonstrated intact alignment and construct stability without complications. LESSONS: In DPEP associated with ACDF, fibular strut allograft and short anterior cervical plates can be used to restore anterior column stability and allow reliable esophageal healing. To the authors' knowledge, this is the first detailed description of this salvage strategy in the setting of post-ACDF DPEP. https://thejns.org/doi/10.3171/CASE25856.