Airway Obstruction After Anterior Cervical Spine Surgery

Gwinnutt, Carl; Walsh, Gina; Kumar, Ravi

doi:10.1097/00008506-199207000-00009

Cited by 12 publications

(5 citation statements)

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“…The single patient with bacterial spondylitis was not a difficult laryngoscopy, but the two patients with axial abscesses we excluded would almost certainly have been difficult. Difficulty has been reported elsewhere [35], as the result of the combination of swelling, neck stiffness and trismus, usually present in these patients. We have seen two cases since the study period, both of which were difficult.…”

Section: Discussionmentioning

confidence: 56%

Difficult direct laryngoscopy in patients with cervical spine disease

1995

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summary Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classijication proposed by Cormack and Lehane. The overall prevalence of dificulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito-atlanto-axial complex have a higher prevalence of dificulty than those with disease below the axis vertebra. Occipito-atlanto-axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of thejrst and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator ofpoor cranio-cervical extension. Dificulty was rare inpatients with class A mandibular protrusion, and invariable in patients with class C protrusion.

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Section: Discussionmentioning

confidence: 56%

Difficult direct laryngoscopy in patients with cervical spine disease

1995

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“…Cervical tissues are dissected and drawn during anterior cervical fixation, which may cause local hyperemia or edema of tissues that manifests as PVST swelling in lateral radiographs. Postoperative PVST swelling may further compress the anterior pharynx, esophagus, or trachea, resulting in complications including dysphagia and respiratory tract obstruction (18)(19)(20)(21)(22)(23)(24)(25). PVST swelling peaks at about day 3 after the operation and gradually alleviates as time went on.…”

Section: Resultsmentioning

confidence: 99%

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Dai¹,

Liu²,

Chen³

et al. 2022

Acta Orthop Belg

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Atlantoaxial segments have not been discussed in existing studies on prevertebral soft tissue (PVST) swelling after cervical operations. This study aimed to investigate the characteristics of PVST swelling after anterior cervical internal fixation at different segments. This retrospective study included patients who underwent transoral atlantoaxial reduction plate (TARP) internal fixation (Group I, n=73), C3/C4 anterior decompression and vertebral fixation (Group II, n=77), or C5/C6 anterior decompression and vertebral fixation (Group III, n=75) at our Hospital. The PVST thickness at C2, C3, and C4 segments was measured before and 3 days after the operation. Time of extubation, number of patients with postoperative re-intubation and dysphagia were collected. Results show that all patients had significant postoperative PVST thickening (all P<0.01). PVST thickening at C2, C3, and C4 was significantly greater in Group I than in Groups II and III (all P<0.01). PVST thickening at C2, C3, and C4 in Group I was 1.87 (14.12mm/7.54mm), 1.82 (12.90mm/7.07mm) and 1.71 (12.09mm/7.07mm) times of that in Group II, respectively. PVST thickening at C2, C3, and C4 in Group I was 2.66 (14.12mm/5.31mm), 1.50 (12.90mm/8.62mm) and 1.32 (12.09mm/9.18mm) times of that in Group III, respectively. The patients in Group I had significantly later postoperative extubation (Both P<0.01) than the patients in Groups II and III. None of the patients had postoperative re-intubation or dysphagia. We conclude that PVST swelling was greater in patients who underwent TARP internal fixation than in patients who underwent anterior C3/C4 or C5/C6 internal fixation. Hence, after TARP internal fixation, patients should be given proper respiratory tract management and monitoring.

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“…Postoperative RPA often presents with signs and symptoms common such as dysphagia, dysphonia, chest pain, and signs of nuchal rigidity [ 1 , 6 ]. Nocturnal and positional dysphagia is frequently reported, in addition to fevers and facial swelling [ 1 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Retropharyngeal Abscess With Severe Airway Compromise Following Anterior Cervical Spine Surgery: A Case Report

Inman¹,

Bridwell²,

Larson³

et al. 2021

Cureus

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Anterior cervical corpectomy, discectomy, and fusion are common surgical management options for symptomatic cervical radiculopathy and myelopathy. While these procedures are common and well-tolerated, postoperative complications span from mild dysphasia to airway compromise secondary to retropharyngeal or peri-cervical space abscess. These critical patients require robust airway management, which may entail a multidisciplinary approach or airway management in the operating room. We describe a patient who developed airway compromise 10 days following anterior cervical discectomy and fusion with a pre-platysmal abscess and a large retropharyngeal abscess. These abscesses were large enough to cause a mass effect with tracheal deviation. This deviation was severe enough that the patient required awake incision and drainage prior to rapid sequence intubation.

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Airway Obstruction After Anterior Cervical Spine Surgery

Cited by 12 publications

References 0 publications

Difficult direct laryngoscopy in patients with cervical spine disease

Difficult direct laryngoscopy in patients with cervical spine disease

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Retropharyngeal Abscess With Severe Airway Compromise Following Anterior Cervical Spine Surgery: A Case Report

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