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Airway compromise due to wound hematoma following anterior cervical spine surgery.

Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J - Open Orthop J (2012)

Bottom Line: One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

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.

No MeSH data available.


Related in: MedlinePlus

Intraoperative lateral cervical spine xray showing anteriorcervical discectomy and fusion of C5/6.
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Figure 1: Intraoperative lateral cervical spine xray showing anteriorcervical discectomy and fusion of C5/6.

Mentions: Anterior cervical discectomy and fusion (ACDF) was performed at the C5-6 level through a transverse, left-sided incision utilizing iliac crest autograft and anterior plate fixation (Fig. 1). There were no intraoperative complications. At the time of wound closure, hemostasis was adequate. The patient was extubated and transferred to the recovery room in stable condition. Six hours following completion of the operation, the patient began complaining of difficulty swallowing and breathing. She was agitated and tachypneic; oxygen saturation was >95% on room air. Her neurologic exam was unchanged from her preoperative exam. Examination of her anterior neck revealed fullness and submandibular edema. The suture line was intact with no incisional drainage. The hemovac drain reservoir showed minimal bloody drainage and the tubing appeared to be clotted.


Airway compromise due to wound hematoma following anterior cervical spine surgery.

Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J - Open Orthop J (2012)

Intraoperative lateral cervical spine xray showing anteriorcervical discectomy and fusion of C5/6.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3299954&req=5

Figure 1: Intraoperative lateral cervical spine xray showing anteriorcervical discectomy and fusion of C5/6.
Mentions: Anterior cervical discectomy and fusion (ACDF) was performed at the C5-6 level through a transverse, left-sided incision utilizing iliac crest autograft and anterior plate fixation (Fig. 1). There were no intraoperative complications. At the time of wound closure, hemostasis was adequate. The patient was extubated and transferred to the recovery room in stable condition. Six hours following completion of the operation, the patient began complaining of difficulty swallowing and breathing. She was agitated and tachypneic; oxygen saturation was >95% on room air. Her neurologic exam was unchanged from her preoperative exam. Examination of her anterior neck revealed fullness and submandibular edema. The suture line was intact with no incisional drainage. The hemovac drain reservoir showed minimal bloody drainage and the tubing appeared to be clotted.

Bottom Line: One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

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.

No MeSH data available.


Related in: MedlinePlus