Risk Factors for Postoperative Retropharyngeal Hematoma After Anterior Cervical Spine Surgery

O’Neill, Kevin; Neuman, Brian J.; Peters, Colleen; Riew, K. Daniel

doi:10.1097/brs.0000000000000139

Cited by 51 publications

(67 citation statements)

References 17 publications

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“…It is well known that the development of such a complication is more common in the acute postoperative period. It has to be emphasized however, that up to 35% of hematomas has been reported to be presented in a delayed fashion, at an average of 6 days postoperatively (28,32). Interestingly, O'Neil et al (28) mentioned that in 27% of their cases a drain was in place, while in 27% of cases the hematoma formed shortly after the drain removal, raising significant questions regarding its role in preventing a postoperative hematoma.…”

Section: Dysphagiamentioning

confidence: 97%

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Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Dysphagiamentioning

confidence: 97%

“…The long list of complications includes infection, abscess, and hematoma formation (20,(26)(27)(28)(29). Additionally, neurovascular or adjacent organ injuries have been reported (17,20,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39).…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

View full text Add to dashboard Cite

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“…Similar to these results, other studies have demonstrated the occurrence of delayed airway compromise 1 to 2 weeks after anterior surgery. 13,20 Yu et al reported that a patient experienced respiratory difficulty with neck swelling 16 days following surgery and was diagnosed with active bleeding from the right superior thyroid artery following emergent angiography. 20 Attending surgeons should therefore be aware that this complication can occur up to 2 weeks postoperatively and should monitor their high-risk patients cautiously during this time period.…”

Section: Discussionmentioning

confidence: 99%

“…Due to a limited sample size, however, this study could not compare pre- and postoperative NDI scores in patients who required reintubation following anterior cervical surgery. 13 In contrast, our multicenter study comprehensively evaluated outcomes in patients with this complication using a variety of assessment tools. Based on our findings, there were no significant differences between baseline and postoperative mJOA or Nurick scores.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients

Nagoshi

Fehlings

Nakashima

et al. 2017

Global Spine Journal

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Study Design:A multicenter, retrospective cohort study.Objective:To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery.Methods:A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey.Results:Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life.Conclusions:Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

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“…Postoperative hematoma after cervical spinal surgery often causes serious complications. For example, postoperative retropharyngeal hematoma is especially well known to occur after anterior cervical spine surgery 1) . A previous study identified the risk factors of postoperative retropharyngeal hematoma as (1) diffuse idiopathic skeletal hyperostosis, (2) ossi-fication of the posterior longitudinal ligament (OPLL), (3) therapeutic heparin use, (4) longer operative time, and (5) greater number of surgical levels 1) .…”

Section: Introductionmentioning

confidence: 99%

A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

Takeuchi¹,

Yokoyama²,

Wada

et al. 2019

Spine Surg Relat Res

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Introduction The purpose of this study was to evaluate surgical outcomes using a new grading of postoperative epidural hematoma (EH) or epidural scar formation after posterior cervical spine surgery. Methods Postoperative EH or epidural scar formation after cervical laminoplasty (LP) or posterior decompression and fusion (PDF) were graded into Grades 1-5 by magnetic resonance imaging at 24 hours, 2 weeks, 6 months, and one year after surgery. The patients were divided into the Mild group (Grades 1-3) and the Severe group (Grades 4, 5). Perioperative factors were compared between the two groups at 24 hours after surgery. Distribution of EH or scar formation was investigated according to two surgeries. The recovery rate of Japanese Orthopedic Association (JOA) scores and the improvements of neck disability index (NDI) were compared between the two groups at one year postoperatively. Results Of the postoperative factors, posterior shift of the cervical spinal cord at C4 and C7 significantly differed between the two groups. Patients in the Severe group at 24 hours after surgery (17%) increased to 41% at 2 weeks and subsequently decreased to 16% at 6 months after LP. After PDF, 3% in the Severe group at 24 hours after surgery increased to 15% at 2 weeks and then decreased to 3% at 6 months postoperatively. Only one (3%) patient remained in the Severe group at 1 year after PDF. The recovery rate of JOA score (47.5%) of the patients in the Mild group showed trend larger than that of the Severe group (34.7%) after LP. Preoperative NDI (15.6 points) significantly improved postoperatively to 12.1 points in only the Mild group after LP. Conclusions The patterns of distribution of EH or scar formation did not differ between the two surgical methods. The severity of postoperative scar formation related to surgical outcomes after LP.

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Risk Factors for Postoperative Retropharyngeal Hematoma After Anterior Cervical Spine Surgery

Abstract: 4.

Cited by 51 publications

References 17 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients

A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

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