Airway Obstruction Due to Tracheomalacia Caused by Innominate Artery Compression and a Kyphotic Cervical Spine

Background: One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF. Case Description: A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5th postoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact. Conclusion: A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.

Download Full-text

Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199403000-00006 ◽

1994 ◽

Vol 76 (3) ◽

pp. 360-365 ◽

Cited By ~ 57

Author(s):

I Wattenmaker ◽

M Concepcion ◽

P Hibberd ◽

S Lipson

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

Airway Obstruction ◽

Perioperative Management ◽

Upper Airway ◽

Upper Airway Obstruction

Download Full-text

Irreversible airway obstruction due to innominate artery compression of the trachea

BMJ Case Reports ◽

10.1136/bcr.11.2011.5075 ◽

2012 ◽

Vol 2012 (feb07 1) ◽

pp. bcr1120115075-bcr1120115075

Author(s):

M. Lukkarinen ◽

H. P. Lukkarinen

Keyword(s):

Airway Obstruction ◽

Innominate Artery ◽

Irreversible Airway Obstruction

Download Full-text

Paradoxical Upper Airway Obstruction and Central Sleep Apnea Developed After Anterior Cervical Spine Fusion

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.2005.58.3.295 ◽

2005 ◽

Vol 58 (3) ◽

pp. 295

Author(s):

Sang Haak Lee ◽

Young Mee Choi ◽

Ye Ree Park ◽

Ji Ho Kang ◽

Young Kyoon Kim ◽

...

Keyword(s):

Cervical Spine ◽

Sleep Apnea ◽

Airway Obstruction ◽

Central Sleep Apnea ◽

Upper Airway ◽

Spine Fusion ◽

Upper Airway Obstruction ◽

Cervical Spine Fusion

Download Full-text

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

Advances in Orthopedics ◽

10.4061/2011/791923 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Masahiro Morita ◽

Masuhiro Nobuta ◽

Hirotsune Naruse ◽

Hiroaki Nakamura

Keyword(s):

Radiation Therapy ◽

Cervical Spine ◽

Airway Obstruction ◽

Spine Surgery ◽

Metastatic Tumor ◽

Upper Cervical Spine ◽

Occipitocervical Fusion ◽

Cervical Spine Surgery ◽

Emergency Tracheostomy ◽

Upper Cervical

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.

Download Full-text