Multidisciplinary management of thoracic esophageal fistula secondary to traumatic upper thoracic fracture (T3–4) with associated discitis/osteomyelitis and spinal epidural abscess: illustrative case

BACKGROUND: An esophageal fistula secondary to a traumatic upper thoracic (T3–4) fracture with resultant thoracic discitis/osteomyelitis and an epidural abscess with neurological compromise is a rare clinical entity. Early diagnosis is critical for an optimal clinical outcome avoiding grave and progressive spinal dissemination with structural instability and neurological deterioration. OBSERVATIONS: The following case, not clearly described previously in the literature, highlights the clinical course and multidisciplinary approach to management including a single-stage posterior cervicothoracic (C3–T6) decompression with vertebral reconstruction with an expandable interbody cage (T2–4) and posterior cervicothoracic fusion and instrumentation (C3–T6), followed by direct esophageal fistula closure with AlloDerm and a vascularized latissimus dorsi muscle flap. LESSONS: Early diagnosis and the potential treatment of a posttraumatic esophageal fistula requires a multidisciplinary approach.