Upper Airway Obstruction After Cervical Spine Fusion Surgery: Role of Cervical Fixation Angle

• Published in: Acta anaesthesiologica Taiwanica 2008-09, Vol.46 (3), p.134-137
• Main Authors: Lee, Yi-Hui, Hsieh, Pei-Fang, Huang, Hui-Hsun, Chan, Kuang-Cheng
• Format: Article
• Language: English
• Subjects: airway obstruction; Airway Obstruction - etiology; cervical vertebrae; Cervical Vertebrae - surgery; Female; Humans; Middle Aged; Postoperative Complications; spinal fusion; Spinal Fusion - adverse effects; Spinal Fusion - methods
• ISSN: 1875-4597
• DOI: 10.1016/S1875-4597(08)60008-9

Upper airway obstruction is one of the life-threatening events in cervical spine surgery. The risk is particularly great during the period immediately after operation. We present the case of a 56-year-old female with breast cancer and metastasis to the cervical spine. The surgical procedure involved C2-C3 laminectomy, posterior fixation (C0-C5), and C2 neurectomy. Tracheal extubation was carried out in the intensive care unit, and upper airway obstruction immediately followed. Emergency cricothyrotomy was performed under well-managed ventilation with a laryngeal mask after several failed intubation attempts. Over-flexion of the cervical spine fixation and severe prevertebral soft tissue swelling were the most probable causes of upper airway obstruction. With a well-adjusted angle for fixation of the cervical spine under fluoroscopic guidance before the procedure, such a surgical mishap could be avoided. Reintubation with a fiberscope might be considered first, and sustaining intubation for 2-3 days postoperatively could be safer in such high risk patients.