Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review

Abstract

Background: One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF. Case Description: A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5th postoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact. Conclusion: A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.

Delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture: a case report

“…Therefore, it has been widely accepted as the gold standard treatment of cervical radiculopathy, myelopathy, and trauma [ 2 ]. However, according to multiple previous studies, dysphagia (1.7 to 9.5%), postoperative retropharyngeal hematoma (1.3% to 5.6%), respiratory insufficiency (1.1%), and esophageal perforation (0.3 to 0.9%) contribute to the morbidity rates for ACDF, which vary from 13.2% to 19.3% [ 5 ]. Among the several complications associated with ACDF, airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery [ 6 , 7 ].…”

“…Among the several complications associated with ACDF, airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery [ 6 , 7 ]. The risk factors for a second hematoma evacuation surgery include three or more level surgeries, obesity, anemia, use of anticoagulation agents, and male gender [ 5 ]. In our case, there were no related risk factors except male gender.…”

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

“…Therefore, it has been widely accepted as the gold standard treatment of cervical radiculopathy, myelopathy, and trauma [2]. However, according to multiple previous studies, dysphagia (1.7 to 9.5%), postoperative retropharyngeal hematoma (1.3-5.6%), respiratory insu ciency (1.1%), and esophageal perforation (0.3 to 0.9%) contribute to the morbidity rates for ACDF, which vary from 13.2-19.3% [5]. Among the several complications associated with ACDF, airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery [6,7].…”

Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time

“…However, the transition to the outpatient setting for anterior cervical spine surgery is controversial due to concern regarding complications, particularly airway compromise or spinal cord compression following postoperative hematoma formation [9] , [10] , [11] . These complications can be life threatening if not recognized and treated promptly [ 12 , 13 ]. A criticism of the outpatient setting has been its low level of postoperative monitoring and limited access to emergency resources, both of which could compromise the management of such complications if they arise [ 12 , 13 ].…”