Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy

Debkowska, Monika; Butterworth, John F.; Moore, John W.; Kang, Soobin; Appelbaum, Eric N.; Zuelzer, Wilhelm A.

doi:10.21037/jss.2019.03.01

Cited by 33 publications

(47 citation statements)

References 56 publications

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“…Pharyngolaryngeal edema is the most likely cause of airway compromise in the 24 to 72-hour period. 9 Clinical manifestations of upper airway edema vary. Early signs typically include dyspnea and difficulty speaking.…”

Section: Discussionmentioning

confidence: 99%

A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation

Mishra

Palmer

et al. 2019

Surg J

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Postoperative airway complications can be a common, yet perhaps underappreciated, complication in patients undergoing cervical spine surgery. Presented here are three cases in which patients experienced postoperative airway compromise, resulting in difficulty establishing a secure airway following cervical spine operations. Establishing factors that contribute to airway complications after cervical spine surgery can aid in early identification of high-risk patients to create an appropriate airway management strategy. Ultimately, the frequency of airway difficulty after removal of the endotracheal tube in patients undergoing cervical spine surgery should not be taken lightly.

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Section: Discussionmentioning

confidence: 99%

A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation

Mishra

Palmer

et al. 2019

Surg J

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“…Additionally, postoperative respiratory complications (PRC) can cause serious problems and major issues after ADF. Past reports indicate that postoperative adverse events of a respiratory nature, such as pneumonia and airway obstruction, occur in 0.6%-14% of patients after ADF [6][7][8]9) . Sometimes, accidental airway obstruction becomes a potentially life-threatening event that may require reintubation, for which one must be prepared with an effective management plan.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

Ohba

Akaike

Fujita

et al. 2021

Spine Surg Relat Res

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Introduction: Postoperative respiratory complications (PRC) are one of the most serious complications. Potentially life-threatening accidents can occur after an anterior cervical discectomy and fusion (ADF), such as airway obstruction and aspiration pneumonia. Despite numerous studies, preoperative predictive and preventive methodology has yet to be established. As reported in our previous study, the evaluation of preoperative dysphagia using the eating assessment tool (EAT-10) and a flexible endoscopic evaluation of swallowing (FEES) is useful for predicting the incidence and risk factors of dysphagia after ADF. Methods: This prospective study comprised 60 consecutive patients who underwent ADF. An otolaryngologist and a speech-language-hearing therapist preoperatively and 1 week postoperatively evaluated dysphagia using EAT-10 and Hyodo-Komagane (H-K) scores during FEES. Patient demographics, comorbidities, and pre-and postoperative dysphagia were compared between patients with and without PRC. Results: Seven of 60 (11.6%) patients had preoperative dysphagia diagnosed using the H-K score. A significant positive correlation existed between the pre-and postoperative H-K scores. Of all 60 cases, eight (13.3%) had PRC. Among them, two required reintubation due to airway obstruction and six had aspiration pneumonia. The PRC(+) group was significantly older and more prone to diabetes and asthma. The preoperative H-K score of the PRC(+) group was significantly higher than that of the PRC(−) group. Postoperatively, but not preoperatively, EAT-10 was significantly higher in the PRC(+) group. Conclusions: Preoperative dysphagia may potentially exacerbate postoperative dysphagia after ADF. A preoperative evaluation of dysphagia using the H-K score during FEES is a useful method for predicting and reducing the risk of PRC.

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“…Therefore, late onset of this complication is rare, as shown in our unique case. Regarding postoperative airway compromise following ACDF, predictable etiologies by time were reported as follows: angioedema (6 to 12 hours), retropharyngeal hematoma (12 to 24 hours), pharyngolaryngeal edema (24 to 72 hours), and retropharyngeal abscess (72 to 96 hours) [4]. Generally, emergent evacuation should be recommended for retropharyngeal hematoma at the time of diagnosis because it can cause life-threatening events due to acute airway compromise.…”

Section: Discussionmentioning

confidence: 99%

Delayed Onset Postoperative Retropharyngeal Hematoma After Anterior Cervical Surgery With a Sequela of Tracheal Stricture: a Case Report

Chang

Park

Hwang

et al. 2021

Preprint

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Background: Among the several complications associated with anterior cervical discectomy and fusion (ACDF), airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery. Postoperative retropharyngeal hematoma commonly occurred during the on immediate phase with airway compromise but have a rarity on late onset of this complication. Enlightened by this existing fact, we report the first case of delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture. Case presentation: A 55-year-old male underwent ACDF for disc herniation at C5-6 that had not responded to conservative treatment over three months. The symptoms significantly improved after surgery, and he was discharged on postoperative day 3. On the seven days after ACDF, the patient complained of sudden onset left-deviated neck swelling. The follow-up plain radiographs and neck-enhanced computed tomography (CT) scans showed anterior and right lateral displacement of the airway including the trachea by a large retropharyngeal hematoma. We performed an emergent forceful endotracheal intubation that was maintained for two days until the patient underwent hematoma evacuation surgery. On the second day after hematoma evacuation surgery, the patient complained of hoarseness with a foul breath odor. Laryngoscopy showed tracheal ischemic mucosal damage that had been induced by forceful endotracheal intubation. Antibiotics and systemic corticosteroids were administered, and the symptoms improved. One month after hematoma evacuation surgery, he complained of dyspnea on exertion, and laryngoscopy showed tracheal stricture. The patient underwent bronchoscopic dilatation and is doing well without recurrence of symptoms. Conclusions: Early surgery to remove the delayed onset retropharyngeal hematoma, rather than forceful endotracheal intubation followed by delayed surgery, might yield better results and avoid unexpected complications of tracheal stricture.

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Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy

Cited by 33 publications

References 56 publications

A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation

A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation

Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

Delayed Onset Postoperative Retropharyngeal Hematoma After Anterior Cervical Surgery With a Sequela of Tracheal Stricture: a Case Report

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