Airway Compromise from Prevertebral Soft Tissue Swelling during Placement of Halo-Traction for Cervical Spine Injury

Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion

“…To the best of our knowledge, there have been only two reports in the international literature addressing this issue [1,2]. Potential causes of airway obstruction in cervical spine surgery or injury include pharyngeal edema [1][2][3][4][5][6], hematoma [7,8], cerebrospinal fluid leak [4,9], angioedema [10], graft or plate dislodgement [11,12], recurrent laryngeal nerve injury [13], and overflexion fixation of the cervical spine [1,2,14]. The most common cause is pharyngeal edema [15].…”

“…The most common cause of this complication is pharyngeal edema [1][2][3][4][5][6]. However, it is not widely known that a cervical fusion in a flexed position may cause upper airway obstruction.…”

Guidelines for Emergency Tracheal Intubation Immediately after Traumatic Injury

“…[83][84][85][86] The need for emergency tracheal intubation in these patients with cervical spine injury is 22% (range, 14 -48%). 41,63,[87][88][89] There is also substantial documentation that patients with other severe neck injuries may have airway obstruction secondary to cervical hematoma and laryngeal or tracheal injury.…”

Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report

“…Despite the low immediate reintubation rate (1.1-1.7%), this complication can be critical once it develops [1]. The major known causes of airway obstruction after cervical spinal surgery are prevertebral soft tissue swelling [2], hematoma [3], cerebral fluid leakage [4], over-flexion fixation of the cervical spine [5], severe angioedema [6], and recurrent laryngeal nerve injury [7]. …”