Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal procedures in the United States. With an excellent outcome in most of them. The complications associated with this procedure are rare but can be troublesome and life threatening. We report the case of a patient that sustained a missed, late esophageal perforation after an anterior cervical discectomy and fusion, leading to multiple abscesses in the epiduaral, paraspinal, mediastinal, parapsoas, and pleural spaces, who survived after multiple procedures and was able to ambulate after a prolonged course of care. A proposed algorithm for treatment is included.

Keywords: ACDF; Multiple epidural abscess; Esophageal perforation.