Cervical edema after anterior cervical fusion, a rare but potentially fatal complication: a case report
Keywords:Cervical edema, Anterior cervical fusion, Airway compromise, Surgical complication
Anterior approaches to the cervical spine can be performed for spine decompression and instrumentation in many pathologic conditions. Cervical spine surgeries complicate in 5.3% of cases, with anterior procedures representing 65% of them. Airway compromise requiring tracheostomy or reintubation is rare but may lead to potentially catastrophic complications. There are several causes for airway compromise, including post-operative cervical swelling or hematoma, pharyngeal edema, cerebrospinal fluid (CSF) leak, angioedema, and graft or implant displacement. We present a case of a 57-year-old male with chronic neck and left radicular pain. He was submitted to C5-C6 anterior cervical disc fusion that was complicated with airway compromise in the orthopedics ward. The patient required emergent reintubation for airway protection, wound exploration and intensive care. Hematoma is often the first diagnosis to consider in the immediate postoperative period. A low threshold for intubation should be maintained. After airway protection, it is essential to differentiate etiologies, to guide subsequent management.
Robinson RASG. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;(4):96:223.
Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976). 2002;27(9):949-53.
Zeidman SE, Ducker TBRJ. Trends and complications in cervical spine surgery. J Spinal Disord. 1997; 10(6):523-6.
Debkowska MP, Butterworth JF, Moore JE, Kang S, Appelbaum EN, Zuelzer WA. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. J Spine Surg. 2019;5(1):142-54.
Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J. Airway Compromise Due to Wound Hematoma Following Anterior Cervical Spine Surgery. Open Orthop J. 2012;6(1):108-13.
Krnacik MJ, Heggeness MH. Severe angioedema causing airway obstruction after anterior cervical surgery. Spine. 1997;22:2188-90.
Wade HJS. Respiratory obstruction in thyroid surgery. Ann R Coll Surg Engl. 1979;62(5):391-2.
Carr ERM, Benjamin E. In vitro study investigating post neck surgery haematoma airway obstruction. J Laryngol Otol. 2009;123(6):662-5.
Qin D, Zhang Q, Zhang YZ, Pan JS, Chen W. Safe drilling angles and depths for plate-screw fixation of the clavicle: Avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury. J Trauma Inj Infect Crit Care. 2010;69(1):162-8.