Pharyngeal and esophageal perforations are rare during cervical spine surgery but can cause significant morbidity. Pharyngeal or eosephageal perforations can occur by several mechanisms and the management of pharyngeal or eosephageal perforation's treatment may become difficult. We report a 41-year-old paraplegic man with an interscapular pharyngocutaneous fistula secondary to cervical vertebral surgery. The diagnosis of posterior fistula was delayed for several months as it was an extremely rare complication. We explored the anterior neck and repaired the perforation on the right pyriform sinus primarily. The fistula tract on the back of the patient was completely healed and the patient started oral feeding in the second week after surgery.