J Korean Orthop Assoc.  2009 Feb;44(1):136-140. 10.4055/jkoa.2009.44.1.136.

Airway Obstruction Caused by Soft Tissue Edema during an Anterior Cervical Approach: A Case Report

• Park BJ
• Choi BW
• Chang JH

• KMID: 2186389
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.136

Abstract

Anterior approaches to the cervical spine for performing decompression, fusion and/or instrumentation are common and useful methods for treating many conditions, including degenerative diseases. One of the rare, but serious complications of an anterior cervical approach is respiratory insufficiency as a result of upper airway obstruction, which is due to airway narrowing and prevertebral soft tissue swelling. We experienced a case of serious airway obstruction that was caused by soft tissue edema combined with postoperative hematoma after an anterior cervical spine approach. We report here on this case and include a review of the relevant literature.

Keyword

Airway obstruction; Soft tissue edema; Anterior cervical spine approach

MeSH Terms

Airway Obstruction
Decompression
Edema
Hematoma
Respiratory Insufficiency
Spine

Figure

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  Fig. 1 C-spine lateral X-ray film. (A) Postop. D-day, anterior cervical discectomy and fusion of C5-7 was performed. (B) Postop. 3rd day, severe prevertebral soft-tissue swelling and airway narrowing was visible. (C) Postop. 6th day, prevertebral soft-tissue swelling was resolved. But tracheal tube was reinserted due to difficulty of respiration. (D) Postop. 15th day, tracheal tube was removed. (E) Postop 6 months. there showed mild collapse of implanted cage with complete union of grafted bone.

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  Fig. 2 (A) Neck CT shows that spindle shaped prevertebral (Lt) and parapharyngeal (Rt) low density, 15×7 mm & 19×5 mm sized, iso-dense abscess like mass with rim enhanced. There was diffuse swelling of retro- and para-pharyngeal area. (B) Extracted soft tissue debridement was dark reddish brown colored, foul odoured and pus-like fluid mixed.

Reference

1. Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine. 2000. 25:2906–2912.

2. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002. 27:2453–2458.

3. Bexton MD, Radford R. An Unusual cause of respiratory obstruction after thyroidectomy. Anaesthesia. 1982. 37:596.

4. Cohn I, Bornside GH. Infections. Principles of surgery. 1989. 5th ed. New York: McGraw Hill;181–215.

5. Emery SE, Smith MD, Bohlman HH. Upper-airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg Am. 1991. 73:544–551.

6. Lee JT, Kingston HG. Airway obstruction due to massive lingual oedema following cleft palate surgery. Can Anaesth Soc J. 1985. 32:265–267.

7. O'sullivan JC, Wells DG, Wells GR. Difficult airway management with neck swelling after carotid endarterectomy. Anaesth Intensive Care. 1986. 14:460–464.

8. Page C, Biet A, Zaatar R, Strunski V. Parapharyngeal abscess: diagnosis and treatment. Eur Arch Otorhinolaryngol. 2008. 265:681–686.

9. Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop. 2006. 30:290–294.