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. 2012:6:108-13.
doi: 10.2174/1874325001206010108. Epub 2012 Mar 5.

Airway compromise due to wound hematoma following anterior cervical spine surgery

Mark A Palumbo  1 , Jessica Pelow Aidlen, Alan H Daniels, Nikhil A Thakur, Joseph Caiati
Affiliations

Airway compromise due to wound hematoma following anterior cervical spine surgery

Mark A Palumbo et al. Open Orthop J. 2012.

Abstract

One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise. The reported incidence of this postoperative complication has varied from 0.2% to 1.9%. Obstruction of the airway secondary to bleeding presents a challenging clinical scenario given the rapidity of onset, distorted anatomy of the upper respiratory tract, urgent need to act and potential for catastrophic consequences. This high-risk, life-threatening clinical scenario requires specialized knowledge and a well-designed treatment protocol to achieve a positive outcome. In this review, we report a case of airway compromise secondary to wound hematoma following anterior cervical discectomy and fusion, followed by a review of relevant literature, anatomy, etiologic factors and diagnostic considerations. We also propose guidelines for the prevention and management of postoperative airway obstruction due to wound hematoma.

Keywords: Anterior cervical spine surgery; adverse event; airway obstruction; hematoma..

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Figures

Fig. (1)
Fig. (1)
Intraoperative lateral cervical spine xray showing anterior cervical discectomy and fusion of C5/6.
Fig. (2)
Fig. (2)
Midsagittal section of the upper respiratory tract. OP: oropharnyx. LP: laryngopharnyx. TR: trachea. ES: esophagus. EP: epiglottis. TC: thyroid cartilage. CC: cricoid cartilage. Arrow A: path for direct laryngoscopic orotracheal intubation. Arrow B: path for surgical cricothyrotomy. Arrow C: path for high surgical traceostomy.
Fig. (3)
Fig. (3)
The anterior cervical approach to the spine (cross-sectional view): note the potential space created by dissection in the plane between the carotid sheath and the midline viscera. The carotid sheath structures are retracted laterally, and the esophagus and trachea are retracted medially to expose the ventral surface of the spine. Adapted with permission from: Albert T, Balderston R, Northrup B. Surgical Approaches to the Spine. Philadelphia: WB Saunders 1997; p. 10 [5].
See this image and copyright information in PMC

References

    1. Tew JM, Mayfield FH. Complications of surgery of the anterior cervical spine. Clin Neurosurg. 1976;23:424–34. - PubMed
    1. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 1989;99:41–50. - PubMed
    1. Emery SE, Bohlman HH, Bolesta MJ, Jones PK. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy: Two to seventeen-year follow-up. J Bone Joint Surg Am. 1998;80A:941–51. - PubMed
    1. Marotta N, Landi A, Tarantino R, Mancarella C, Ruggeri A, Delfini R. Five-year outcome of stand-alone fusion using carbon cages in cervical disc arthrosis. Eur Spine J. 2011;20(Suppl 1):S8–12. - PMC - PubMed
    1. Albert T, Balderston R, Northrup B. Surgical approaches to the spine. Philadelphia: WB Saunders; 1997. p. 10.

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