Prolonged Airway Obstruction after Posterior Occipitocervical Fusion: A Case Report and Literature Review

Abstract

The purpose of this paper was to inform the reader that prolonged upper airway obstruction after posterior cervical spine surgery is a possible complication for patients with metastatic tumor of upper cervical spine. A 49-year-old man presented severe neck pain during posture changes due to metastatic spinal tumor of C2. Occipitocervical fusion following removal of the posterior arch of C1 and laminectomy of C2 via the single posterior approach was performed 2 weeks after radiation therapy. After the surgery, life-threatening airway obstruction due to pharyngeal oedema occurred immediately after extubation that required emergency tracheostomy. The airway obstruction did not improve well during the patient's postoperative course. Once pharyngeal oedema occurs in patients with metastatic tumor of upper cervical spine who undergo posterior cervical spine surgery following radiation therapy to the neck, the pharyngeal oedema may be constant for a long period of time.

Retrospective audit of airway management practices in children with craniocervical pathology

“…The incidence of postoperative airway obstruction for cervical spine procedures is 2.8%‐7.8%, of which 1.2%‐3.9% requires re‐intubation and our study reflects this . Despite being a high‐risk group for postoperative airway complications, significant events were rare in our cohort.…”

“…Patients are at risk of airway obstruction postoperatively due to laryngopharyngeal edema secondary to gravitational soft tissue swelling and prone positioning, and ensuring unobstructed venous drainage during the procedure can reduce this. Airway obstruction may also occur with fixation of the head relative to the cervical spine; in particular with flexed cervical positions after posterior occipitocervical fusion due to fixation in suboptimal alignment, particularly excessive flexion . These airway emergencies may require immediate readjustment of the halo and so it is essential that the surgical team remain with the patient until airway patency has been confirmed and the patient is breathing adequately.…”

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

“…This position leads to distortion of the supraglottic airway with significant risk of postoperative airway obstruction . In such cases, intra‐operative fluoroscopy may be used to adjust the position to allow an adequate pharyngeal space postoperatively, as well as the use of an airway exchange catheter technique for possible re‐intubation .…”

An update on the prone position: Continuing Professional Development

“…[23][24][25][26] Les raisons rapportées pour expliquer l'obstruction des voies aériennes et l'échec des tentatives de rétablissement des voies aériennes incluent une macroglossie, un oedème supraglottique/laryngé, un traumatisme chirurgical direct aux tissus mous paratrachéaux (pendant des chirurgies de la colonne cervicale postérieure), et une traction / un traumatisme aux canaux salivaires (entraînant une enflure au niveau du pharynx). L'oedème des voies aériennes supérieures et la macroglossie peuvent être causées par une compression locale directe, une obstruction veineuse ou lymphatique (à cause de la rotation du cou ou de son hyperflexion), et/ou une hypoperfusion tissulaire due à une hypotension systémique.…”

“…[23][24][25][26] The reported reasons for loss of airway patency and failure to re-establish the airway include macroglossia, supraglottic/laryngeal edema, direct surgical trauma to the paratracheal soft tissues (during posterior cervical spine surgeries), and traction/trauma to the salivary ducts (resulting in pharyngeal swelling). Upper airway edema and macroglossia can result from local compression (e.g., oral airways), venous or lymphatic obstruction (from neck rotation/hyperflexion), and tissue hypoperfusion due to systemic hypotension.…”