Tuberc Respir Dis.  2005 Mar;58(3):295-298. 10.4046/trd.2005.58.3.295.

Paradoxical Upper Airway Obstruction and Central Sleep Apnea Developed After Anterior Cervical Spine Fusion

• Lee SH
• Choi YM
• Park YR
• Kang JH
• Kim YK
• Kim KH
• Song JS
• Park SH
• Moon HS

• KMID: 2009839
• DOI: http://doi.org/10.4046/trd.2005.58.3.295

Abstract

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

Keyword

Anterior cervical spine surgery; Central sleep apnea; Laser-assisted uvulopalatoplasty; Paradoxical upper airway obstruction

MeSH Terms

Airway Obstruction*
Apnea
Continuous Positive Airway Pressure
Humans
Intervertebral Disc
Magnetic Resonance Imaging
Middle Aged
Nasopharynx
Polysomnography
Pseudarthrosis
Respiration
Sleep Apnea, Central*
Sleep Initiation and Maintenance Disorders
Snoring
Spinal Fusion
Spine*
Transplants