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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

The anterior cervical approach to the spine (cross-sectional view): note the potential space created by dissection in the planebetween the carotid sheath and the midline viscera. The carotid sheath structures are retracted laterally, and the esophagus and trachea areretracted medially to expose the ventral surface of the spine. Adapted with permission from: Albert T, Balderston R, Northrup B. SurgicalApproaches to the Spine. Philadelphia: WB Saunders 1997; p. 10 [5].
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Figure 3: The anterior cervical approach to the spine (cross-sectional view): note the potential space created by dissection in the planebetween the carotid sheath and the midline viscera. The carotid sheath structures are retracted laterally, and the esophagus and trachea areretracted medially to expose the ventral surface of the spine. Adapted with permission from: Albert T, Balderston R, Northrup B. SurgicalApproaches to the Spine. Philadelphia: WB Saunders 1997; p. 10 [5].

Mentions: The surgical exposure for anterior cervical spine surgery can be performed from either side of the midline via a transverse or longitudinal incision. Access to the vertebral column is achieved by dissection in the plane between the carotid sheath and the midline viscera (Fig. 3) [5]. During surgery, the upper airway structures and esophagus are retracted in a medial direction. The longus colli musculature is elevated off the ventral surface of the spine to expose the vertebral bodies and disc spaces. This exposure creates a potential space along one side and directly posterior to the larynx and trachea.


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)

The anterior cervical approach to the spine (cross-sectional view): note the potential space created by dissection in the planebetween the carotid sheath and the midline viscera. The carotid sheath structures are retracted laterally, and the esophagus and trachea areretracted medially to expose the ventral surface of the spine. Adapted with permission from: Albert T, Balderston R, Northrup B. SurgicalApproaches to the Spine. Philadelphia: WB Saunders 1997; p. 10 [5].
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: The anterior cervical approach to the spine (cross-sectional view): note the potential space created by dissection in the planebetween the carotid sheath and the midline viscera. The carotid sheath structures are retracted laterally, and the esophagus and trachea areretracted medially to expose the ventral surface of the spine. Adapted with permission from: Albert T, Balderston R, Northrup B. SurgicalApproaches to the Spine. Philadelphia: WB Saunders 1997; p. 10 [5].
Mentions: The surgical exposure for anterior cervical spine surgery can be performed from either side of the midline via a transverse or longitudinal incision. Access to the vertebral column is achieved by dissection in the plane between the carotid sheath and the midline viscera (Fig. 3) [5]. During surgery, the upper airway structures and esophagus are retracted in a medial direction. The longus colli musculature is elevated off the ventral surface of the spine to expose the vertebral bodies and disc spaces. This exposure creates a potential space along one side and directly posterior to the larynx and trachea.

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