# Esophageal Injury in Patients with Ankylosing Spondylitis After Cervical Spine Trauma: Our Case Series and Narrative Review

## TL;DR

This paper discusses rare but serious esophageal injuries in ankylosing spondylitis patients after cervical spine trauma, emphasizing the need for early detection and multidisciplinary care.

## Contribution

The paper highlights the under-recognized risk of esophageal injury in AS patients with cervical trauma and outlines diagnostic and treatment challenges.

## Key findings

- Esophageal injuries in AS patients are often missed due to subtle symptoms and require advanced imaging for detection.
- Management requires a multidisciplinary approach, but these patients still face high risks of infection and mortality.
- Early recognition and careful surgical planning are critical to improving outcomes in these cases.

## Abstract

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that causes progressive ossification and fusion of the spine, particularly in the cervical region. This results in a rigid spinal column that is highly susceptible to unstable fractures, even after low-energy trauma. Cervical fractures in AS are often complex, extending through multiple spinal segments, and are associated with a high risk of neurological compromise. Esophageal injury associated with such fractures is rare but clinically significant, as the anatomical vicinity of the esophagus makes it vulnerable to direct trauma, delayed perforation, or secondary damage from fracture displacement and hardware failure. Aim: The purpose of this review is to present and highlight the clinical relevance of esophageal injury in cervical spine trauma among patients with AS, emphasizing the diagnostic challenges and surgical treatment in order to improve outcomes. Results: Esophageal injuries in the context of AS-related cervical trauma are frequently overlooked due to subtle clinical manifestations such as dysphagia, subcutaneous emphysema, or covert signs of mediastinitis. Plain radiographs are insufficient to identify such complications; advanced imaging modalities are often required for detection. Management is complex and usually demands a multidisciplinary approach, involving both stabilization of the cervical spine and repair of the esophagus. Despite treatment efforts, these patients remain at increased risk for morbidity and mortality, mainly due to infection and sepsis. Conclusions: Esophageal injury in cervical spine trauma associated with AS is an uncommon but life-threatening condition. Early recognition, comprehensive radiologic evaluation, and careful surgical planning are crucial for optimal management. Heightened clinical suspicion and awareness of this rare complication are essential to improve diagnostic accuracy and patient outcomes.