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von Glinski A, Pierre CA, Elia C, Ishak B, Godolias P, Blecher R, Detorri JR, Norvell DC, Jouppi L, Gerstmeyer J, Deem SA, Golden JB, Schildhauer TA, Oskouian RJ, Chapman JR. The Postoperative Airway Compromise Score-First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery. World Neurosurg 2024; 187:e714-e721. [PMID: 38692566 DOI: 10.1016/j.wneu.2024.04.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion. This study aims to develop a score to identify patients at risk of acute postoperative airway compromise (PAC). METHODS Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified of 1466 patients who underwent elective anterior cervical discectomy and fusion between July 2014 and May 2019. A comparison group was created by a randomized selection process (non-PAC group). Factors associated with PAC and a P value of < 0.10 were entered into a logistic regression model and coefficients contributed to each risk factor's overall score. Calibration of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Quantitative discrimination was calculated, and the final model was internally validated with bootstrap sampling. RESULTS We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, American Society of Anesthesiologists class >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (above C4), and duration of surgery >179 minutes. The final prediction model included 5 predictors with very strong performance characteristics. These 5 factors formed the PAC score, with a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). CONCLUSIONS The acute PAC score demonstrates strong performance characteristics. The PAC score might help identify patients at risk of upper airway compromise caused by surgical site abnormalities.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, USA; Katholisches Klinikum St. Josef, Orthopedic University Hospital Bochum, Bochum, Germany
| | - Clifford A Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
| | - Christopher Elia
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Periklis Godolias
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Essen, Germany
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | | | | | - Luke Jouppi
- Seattle Science Foundation, Seattle, Washington, USA
| | - Julius Gerstmeyer
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Steven A Deem
- Neurocritical Care, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - J Blake Golden
- Division of Head and Neck Surgery, Swedish Cancer Institute, Seattle, Washington, USA
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
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Tanaka A, Onishi E, Hashimura T, Ota S, Takeuchi H, Tsukamoto Y, Yamashita S, Mitsuzawa S, Yasuda T. Risk Factors for Reintubation After Anterior Cervical Spine Surgery: Comparative Study of Patients With Cervical Spine Trauma and Patients With Cervical Degenerative Disease. Clin Spine Surg 2024; 37:203-209. [PMID: 37941121 DOI: 10.1097/bsd.0000000000001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVES The aim was to compare the postoperative outcomes of anterior cervical spine surgery (ACSS) in patients with and without cervical spine trauma. SUMMARY OF BACKGROUND Few papers have addressed airway obstruction after anterior ACSS for patients with cervical spine trauma. This study aimed to compare airway obstruction after ACSS between patients with cervical degenerative disorders and cervical spine injuries and identify the risk factors for unplanned postoperative reintubation. MATERIALS AND METHODS Seventy-seven patients who underwent ACSS were enrolled in this retrospective study. There were 52 men and 25 women, with a mean age of 60.3±15.5 years old. The causes of surgery were as follows: 24 cervical spine fractures or dislocations, 12 spinal cord injuries without bony fracture, 19 disc herniations, and 22 myelopathies. The patients' characteristics, operative data, and risk factors for unplanned reintubation within 5 days postoperatively were analyzed using medical records. RESULTS Postoperative reintubation was performed in 3 patients (3.9%), all of whom suffered trauma. We further examined risk factors for reintubation in patients in the trauma group. There was no significant difference between the reintubation (R) and nonreintubation (non-R) groups in age, sex, body mass index, amount of blood loss and operation time, preoperative paralysis severity, and the number of fused segments. Patients in group R had significantly higher rates of severe anterior element injury (100% vs. 27.3%, P =0.0011). Airway obstruction due to laryngopharyngeal edema and swelling was confirmed by laryngoscopy and computed tomography images. CONCLUSIONS Unplanned reintubation after ACSS occurred at a higher rate in trauma patients than in patients with degenerative disorders. Our results suggested that the severe damage to the anterior element of the cervical spine was associated with postoperative reintubation. EVIDENCE LEVEL Level IV.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopedic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
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Fujikawa Y, Ikeda N, Sakai K, Omura N, Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Yokoyama K, Kawanishi M, Fujishiro T, Park Y, Tanabe H, Takami T, Wanibuchi M. Postoperative Airway Management after Anterior Cervical Spine Surgery: Retrospective Neurosurgical Multicenter Study. Neurol Med Chir (Tokyo) 2024; 64:205-213. [PMID: 38569916 PMCID: PMC11153843 DOI: 10.2176/jns-nmc.2023-0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 04/05/2024] Open
Abstract
Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation, unplanned reintubation, and/or necessity of tracheostomy. The present study aimed to identify the surgical risks associated with postoperative airway complications in neurosurgical training institutes. A retrospective, multicenter, observational review of data from 365 patients, who underwent anterior cervical spine surgery between 2018 and 2022, at three such institutes was carried out. Postoperative airway complication was defined as either the need for prolonged intubation on the day of surgery or the need for unplanned reintubation. The perioperative medical information was obtained from their medical records. The average age of the cohort was over 60 years, with males comprising approximately 70%. Almost all surgeries predominantly involved anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion, with most surgeries occurring at the level of C5/6. In total, 363 of 365 patients (99.5%) were extubated immediately after surgery, and the remaining two patients were kept under intubation because of the risk of airway complications. Of the 363 patients who underwent extubation immediately after surgery, two (0.55%) required reintubation because of postoperative airway complications. Patients who experienced airway complications were notably older and exhibited a significantly lower body mass index. The results of this study suggested that older and frailer individuals are at an elevated risk for postoperative airway complications, with immediate postoperative extubation generally being safe but requiring careful judgment in specific cases.
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Affiliation(s)
- Yoshiki Fujikawa
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Kosuke Sakai
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Naoki Omura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | | | | | - Yangtae Park
- Department of Neurosurgery, Tanabe Neurosurgical Hospital
| | - Hideki Tanabe
- Department of Neurosurgery, Tanabe Neurosurgical Hospital
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
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De La Torre L, Huang K, Angulo JE, Ramirez CA. Surgical Management of a Traumatic Retropharyngeal Hematoma in a Patient on Dual Antiplatelet Therapy: A Case Report. J Oral Maxillofac Surg 2024; 82:595-599. [PMID: 38387856 DOI: 10.1016/j.joms.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
The authors present a case report of a 73-year-old male on dual antiplatelet therapy with a retropharyngeal hematoma after a motor vehicle accident. We highlight the clinical, radiographic manifestations, and surgical management of retropharyngeal hematomas, especially on an initially asymptomatic patient. Additionally, we demonstrate the importance of establishing a secure airway early on, and multidisciplinary collaboration to maximize patient outcomes.
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Affiliation(s)
- Liana De La Torre
- Resident, Department of Oral and Maxillofacial Surgery, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Kevin Huang
- Oral and Maxillofacial Surgeon, Private Practitioner, Seattle, WA
| | - Jonattan E Angulo
- Professor, Head and Neck Oncology and Microvascular Reconstructive Surgeon, Oral and Maxillofacial Surgeon, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Carlos A Ramirez
- Program Director, Head and Neck Oncology Microvascular Reconstructive Surgeon, Oral and Maxillofacial Surgeon, Ascension Macomb-Oakland Hospital, Warren, MI.
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Nagano S, Unuma K, Makino Y, Mori H, Uemura K. Acute upper airway obstruction due to cervical hematoma after cervicofacial liposuction. J Forensic Leg Med 2024; 104:102697. [PMID: 38772270 DOI: 10.1016/j.jflm.2024.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Liposuction is a surgical procedure performed worldwide. Although many fatal complications of liposuction have been reported, to our knowledge, no cases of fatal liposuction complications specifically related to the face region have been reported. Here, we present a case of a woman in her 30s who developed a cervical hematoma and upper airway obstruction following facial liposuction. We present this unique case to highlight the rare occurrence of fatal complications specific to facial liposuction. The patient underwent liposuction during surgery at a cosmetic surgical clinic and awoke from anesthesia after the procedure. Two hours later, she developed a neck swelling and dyspnea. While the anesthesiologist managed her airway, she went into cardiopulmonary arrest. She was then transferred to the emergency room but died on day 7 of hospitalization. The autopsy revealed swelling of the right cheek and mandible, a subcutaneous hematoma in the same area, and laryngeal edema. A damaged facial artery branch was identified, which was consistent with the computed tomography (CT) findings on admission. CT also showed that the hematoma compressed the right internal jugular vein, suggesting that venous outflow impairment caused by the hematoma may have exacerbated the airway obstruction. This case reveals that cervical hematoma caused by facial liposuction can cause fatal upper airway obstruction and the onset of the hematoma may be gradual.
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Affiliation(s)
- Shutaro Nagano
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Yamada K, Yoshii T, Hirai T, Kudo A, Nosaka N, Egawa S, Matsukura Y, Inose H, Okawa A. Action protocol of medical staff for airway obstruction after anterior cervical spine surgery: A systematic review of case reports. J Orthop Sci 2024:S0949-2658(24)00056-3. [PMID: 38575427 DOI: 10.1016/j.jos.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients' symptoms to prevent unfavorable outcomes. METHODS An extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded. RESULTS Twenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes. CONCLUSION The early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Takashi Hirai
- Department of Orthopaedics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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Rai V, Sharma V, Kumar M, Thakur L. A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:141-152. [PMID: 38957769 PMCID: PMC11216642 DOI: 10.4103/jcvjs.jcvjs_168_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/30/2024] [Indexed: 07/04/2024] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications. Objective To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research. Methods To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria. Results The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%. Conclusion Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.
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Affiliation(s)
- Vikramaditya Rai
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Vipin Sharma
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Mukesh Kumar
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Lokesh Thakur
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
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Colón LF, Barber L, Soffin E, Albert TJ, Katsuura Y. Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors. Global Spine J 2023; 13:2526-2540. [PMID: 36892830 PMCID: PMC10538311 DOI: 10.1177/21925682231160072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVE To provide an overview of etiology and risk factors of airway complications after anterior cervical spine surgery (ACSS). METHODS A search was performed in PubMed and adapted for use in other databases, including Embase, Cochrane Library, Cochrane Register of Controlled Trials, Health Technology Assessment database, and NHS Economic Evaluation Database. RESULTS 81 full-text studies were reviewed. A total of 53 papers were included were included in the review and an additional four references were extracted from other references. 39 papers were categorized as etiology and 42 as risk factors. CONCLUSIONS Most of the literature on airway compromise after ACSS is level III or IV evidence. Currently, there are no systems in place to risk-stratify patients undergoing ACSS regarding airway compromise or guidelines on how to manage patients when these complications do occur. This review focused on theory, primarily etiology and risk factors.
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Affiliation(s)
- Luis Felipe Colón
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | - Lauren Barber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ellen Soffin
- Department of Anesthesiology, Critical Care, and Pain Management; Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yoshihiro Katsuura
- Department of Orthopaedic and Spine Surgery, Adventist Health Howard Memorial Hospital, Willits, CA, USA
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Wang H, Yu H, Zhang N, Xiang L. Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases. Neurospine 2023; 20:525-535. [PMID: 37401070 PMCID: PMC10323355 DOI: 10.14245/ns.2245066.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases. METHODS Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT. RESULTS Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038). CONCLUSION Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Ning Zhang
- Department of Orthopedics, The Second Hospital of Chaoyang, Chaoyang, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
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10
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Stagg PL. Bronchoscope-Guided Airway Rescue via an I-gel™ for Haematoma-Induced Airway Obstruction Following Anterior Cervical Spine Surgery. Cureus 2023; 15:e34990. [PMID: 36938177 PMCID: PMC10019941 DOI: 10.7759/cureus.34990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Airway obstruction requiring emergency airway rescue is an uncommon yet potentially fatal complication following anterior cervical discectomy and fusion. This report describes rapid clinical deterioration after anterior cervical discectomy and fusion despite haematoma evacuation. After failing to secure the airway with awake bronchoscope-guided tracheal intubation and video-laryngoscopy, an I-gel™ supraglottic airway was inserted, and alveolar oxygenation was restored. Bronchoscope-guided intubation was easily achieved via the I-gel™ lumen. The practicality of this technique for airway rescue in the context of a high-stakes time-critical airway emergency is discussed.
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Affiliation(s)
- Philip L Stagg
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, AUS
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11
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Sato MP, Otsuki N, Koike S, Yasumatsu R. Three Cases of Hematoma in the Retropharyngeal Space. EAR, NOSE & THROAT JOURNAL 2022:1455613221141231. [PMID: 36416101 DOI: 10.1177/01455613221141231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Hematoma in the retropharyngeal space (RPS) is a life-threatening condition that leads to rapid airway obstruction. However, the indication for airway management remains unclear. Additionally, the requirement for surgical hematoma evacuation remains undetermined. Therefore, we attempt to suggest some criteria for the management of hematoma in such cases. METHODS We report three cases of hematoma in the RPS wherein one patient was treated without surgery and the other two underwent tracheotomy followed by hematoma evacuation. RESULTS We found that airway management should be based on whether the glottis could be visible on laryngoscopy and dyspnea severity. The degree of hematoma, swelling, subcutaneous bleeding in the anterior neck, and emotional stability should also be considered. Proper management during the acute phase may allow for conservative treatments. Hematomas extending below the tracheal bifurcation may help ease upper airway obstruction due to pressure distribution, allowing for conservative treatment. When hematomas are surgically evacuated, tracheotomy should be performed simultaneously. Our report suggests that mediastinal hematoma evacuation could be avoided. CONCLUSION We should determine a therapeutic strategy for hematoma in RPS based on glottis visualization, patient's condition, and extent of hematoma growth under careful observation.
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Affiliation(s)
- Mitsuo P Sato
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Naoki Otsuki
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Koike
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
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Boddapati V, Lee NJ, Mathew J, Held MB, Peterson JR, Vulapalli MM, Lombardi JM, Dyrszka MD, Sardar ZM, Lehman RA, Riew KD. Respiratory Compromise After Anterior Cervical Spine Surgery: Incidence, Subsequent Complications, and Independent Predictors. Global Spine J 2022; 12:1647-1654. [PMID: 33406919 PMCID: PMC9609542 DOI: 10.1177/2192568220984469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Respiratory compromise (RC) is a rare but catastrophic complication of anterior cervical spine surgery (ACSS) commonly due to compressive fluid collections or generalized soft tissue swelling in the cervical spine. Established risk factors include operative duration, size of surgical exposure, myelopathy, among others. The purpose of this current study is to identify the incidence and clinical course of patients who develop RC, and identify independent predictors of RC in patients undergoing ACSS for cervical spondylosis. METHODS A large, prospectively-collected registry was used to identify patients undergoing ACSS for spondylosis. Patients with posterior cervical procedures were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate analysis was employed to compare postoperative complications and identify independent predictors of RC. RESULTS 298 of 52,270 patients developed RC (incidence 0.57%). Patients who developed RC had high rates of 30-day mortality (11.7%) and morbidity (75.8%), with unplanned reoperation and pneumonia the most common. The most common reason for reoperations were hematoma evacuation and tracheostomy. Independent patient-specific factors predictive of RC included increasing patient age, male gender, comorbidities such as chronic cardiac and respiratory disease, preoperative myelopathy, prolonged operative duration, and 2-level ACCFs. CONCLUSION This is among the largest cohorts of patients to develop RC after ACSS identified to-date and validates a range of independent predictors, many previously only described in case reports. These results are useful for taking preventive measures, identifying high risk patients for preoperative risk stratification, and for surgical co-management discussions with the anesthesiology team.
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Affiliation(s)
- Venkat Boddapati
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA,Venkat Boddapati, Columbia University Irving
Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA.
| | - Nathan J. Lee
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Mathew
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B. Held
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joel R. Peterson
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Meghana M. Vulapalli
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M. Lombardi
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Marc D. Dyrszka
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan M. Sardar
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald A. Lehman
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - K. Daniel Riew
- The Spine Hospital, New
York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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13
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Yuan H, Yu H, Liu L, Zheng B, Wang L, Wang H. Risk factors for predicting increased surgical drain output in patients after anterior cervical decompression and fusion. World Neurosurg 2022; 164:e980-e991. [DOI: 10.1016/j.wneu.2022.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
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14
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Chang DG, Park JB, Kim HJ, Park SB. Delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture: a case report. Eur J Med Res 2021; 26:77. [PMID: 34284813 PMCID: PMC8290576 DOI: 10.1186/s40001-021-00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Among the several complications associated with anterior cervical discectomy and fusion (ACDF), airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery. Postoperative retropharyngeal hematoma commonly occurred during the on immediate phase with airway compromise, but have a rarity on late onset of this complication. Enlightened by this existing fact, we report the first case of delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture. Case presentation A 55-year-old male underwent ACDF for disc herniation at C5–6 that had not responded to conservative treatment over 3 months. The symptoms significantly improved after surgery, and he was discharged on postoperative day 3. On the 7 days after ACDF, the patient complained of sudden-onset left-deviated neck swelling. The follow-up plain radiographs and neck-enhanced computed tomography (CT) scans showed anterior and right lateral displacement of the airway including the trachea by a large retropharyngeal hematoma. We performed an emergent forceful endotracheal intubation that was maintained for 2 days until the patient underwent hematoma evacuation surgery. On the second day after hematoma evacuation surgery, the patient complained of hoarseness with a foul breath odor. Laryngoscopy showed tracheal ischemic mucosal damage that had been induced by forceful endotracheal intubation. Antibiotics and systemic corticosteroids were administered, and the symptoms improved. One month after hematoma evacuation surgery, he complained of dyspnea on exertion, and laryngoscopy showed tracheal stricture. The patient underwent bronchoscopic dilatation and is doing well without recurrence of symptoms. Conclusions Early surgery to remove the delayed onset retropharyngeal hematoma, rather than forceful endotracheal intubation followed by delayed surgery, might yield better results and avoid unexpected complications of tracheal stricture.
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Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, 11765, Gyeonggi-do, Korea.
| | - Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Soo-Bin Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Zhu WP, Fang X, Chooah O, Albaqali SM, Lin W. Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation. Surg Radiol Anat 2021; 43:1769-1776. [PMID: 34120193 DOI: 10.1007/s00276-021-02784-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the potential risk of the retropharyngeal internal carotid artery (RICA) during nasotracheal intubation (NTI). METHODS We retrospectively surveyed 2028 patients and 90 healthy controls (HC) with neck computed tomography angiography (CTA). The incidence of RICA was analyzed, as well as the correlation between the average minimum carotid-pharyngeal distance (CPD) and the carotid-median plane distance (CMD). We also compared CPD between RICA and HC. RESULTS RICA was observed in 91 out of the 2028 patients, reaching an incidence of 4.5% (91/2028). RICA in female patients was 65.9% (60/91) compared to 34.1% (31/91) in male patients. The incidence of RICA at nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) was 31.9% (29/91), 61.5% (56/91), and 6.6% (6/91), respectively. The incidence of the mucosal eminence of the posterior wall of the pharynx in RICA was 30.8% (28/91). In 15 cases, RICA caused the pharyngeal cavity to become narrow, with an incidence of 16.5% (15/91). Moreover, CPD and CMD was positively correlated (r = 0.56, p < 0.01). The average minimum CPD of RICA was only 2.25 ± 1.26 mm, which was much shorter than HC (17.62 ± 1.98 mm) (t = 62.46, p < 0.01). Some CPD of RICA was even less than 1 mm, with an incidence of 20.9% (19/91). CONCLUSION RICA is not uncommon in asymptomatic adults. It is very close to the midline and posterior wall of the pharynx and is more likely to occur in the nasopharynx (NP) and oropharynx (OP). RICA tear is likely to occur during NTI.
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Affiliation(s)
- Wan-Ping Zhu
- Post Anesthesia Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Hangzhou, 310016, China.
| | - Xiao Fang
- Anesthesiology Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Samar Mohamed Albaqali
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Lin
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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16
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von Glinski A, Elia C, Yilmaz E, Frieler S, Ishak B, Anand MK, Iwanaga J, Abdul-Jabbar A, Oskouian RJ, Tubbs RS, Chapman JR. Space-Occupying Lesions of the Retropharyngeal Space: An Anatomical Study With Application to Postoperative Retropharyngeal Hematomas. Global Spine J 2021; 11:704-708. [PMID: 32875906 PMCID: PMC8165929 DOI: 10.1177/2192568220922192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
STUDY DESIGN Cadaver study. OBJECTIVE The retropharyngeal space's (RPS's) clinical relevance is apparent in anterior cervical spine surgery with respect to postoperative hematoma, which can cause life-threatening airway obstruction. This cadaver study aims to establish guidance toward a better understanding of the tolerance of the RPS to accommodate fluid accumulation. METHODS Five fresh-frozen cadavers were dissected in the supine position. A digital manometer and a 20 Fr Foley catheter were inserted into the RPS via an anterolateral approach. While inflating the Foley catheter, the position of the esophagus/trachea was documented using fluoroscopy, and the retropharyngeal pressure was measured. We quantified the volume required to deviate the esophagus/trachea >1 cm from its original position using fluoroscopy. We also recorded the volume required to cause a visible change to the normal neck contour. RESULTS A mean volume of 12.5 mL (mean pressure 1.50 mm Hg) was needed to cause >1 cm of esophageal deviation. Tracheal deviation was encountered at a mean volume of 20.0 mL (mean pressure of 2.39 mm Hg). External visible clinical neck contour changes were apparent at a mean volume of 39 mL. CONCLUSION A relatively small volume of fluid in the RPS can cause the esophagus/trachea to radiographically deviate. The esophagus is the structure in the RPS to be most influenced by mass effect. The mean volume of fluid required to cause clinically identifiable changes to the normal neck contour was nearly double the volume required to cause 1 cm of esophageal/tracheal deviation in a cadaver model.
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Affiliation(s)
- Alexander von Glinski
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA,Ruhr University Bochum, Bochum, Germany,Swedish Hospital, Seattle, Washington, DC, USA,Alexander von Glinski, Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98122, USA.
| | - Christopher Elia
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | | | - Sven Frieler
- Swedish Medical Center, Seattle, Washington, DC, USA
| | - Basem Ishak
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, DC, USA,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
| | - Amir Abdul-Jabbar
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | - Rod J. Oskouian
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | - R. Shane Tubbs
- Swedish Medical Center, Seattle, Washington, DC, USA,St George’s University, Grenada, West Indies,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
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17
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Alhashash M, Allouch H, Boehm H, Shousha M. Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages. Asian Spine J 2021; 16:82-91. [PMID: 33687861 PMCID: PMC8873996 DOI: 10.31616/asj.2020.0463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This is a retrospective study with a minimum follow-up of 2 years. Purpose The aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages. Overview of Literature Over the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. However, research on their application in the treatment of four-level diseases is insufficient. Methods In this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using stand-alone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Analog Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage. Results The mean follow-up was 47±11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4±9.3 at presentation to 8.3±6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5° preoperatively to a mean of 15° postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm. Conclusions Overall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.
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Affiliation(s)
- Mohamed Alhashash
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
| | - Hassan Allouch
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Heinrich Boehm
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Mootaz Shousha
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
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18
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Basil GW, Sprau AC, Starke RM, Levi AD, Wang MY. Large prevertebral hematoma and carotid pseudoaneurysm following percutaneous anterior cervical discectomy: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2055. [PMID: 36046773 PMCID: PMC9394224 DOI: 10.3171/case2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The percutaneous, endoscope-assisted anterior cervical discectomy is a relatively new procedure, and because of its novelty, complications are minimal and pertinent literature is scarce. This approach relies on a sufficient anatomical understanding of the vital neurovascular structures in the operating workspace. Although complications are rare, they can be significant. OBSERVATIONS The patient presented with difficulty breathing following an anterior percutaneous cervical discectomy performed at an outpatient surgical center. Imaging revealed a prevertebral hematoma and multiple carotid pseudoaneurysms. Given the large prevertebral hematoma and concern for imminent airway collapse, the authors proceeded with emergent intubation and surgical evacuation of the clot. LESSONS The authors propose managing complications in a fashion similar to those for comparable injuries after classic anterior approaches. Definitive management of our patient’s carotid injury would require stenting and, therefore, dual antiplatelet agents. Thus, the authors proceeded with the hematoma evacuation first. Additionally, careful dissection was needed to decrease further carotid damage. Thus, the authors made a more rostral incision to maintain the given stability of the carotid insult before the angiographic intervention to follow. It is the authors’ hope that the technical pearls from this two-staged open hematoma evacuation and endovascular stenting may guide future presurgical and intraoperative planning and management of complications, should they arise.
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Affiliation(s)
- Gregory W. Basil
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Annelise C. Sprau
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Allan D. Levi
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Michael Y. Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida
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19
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Sugiura G, Takahashi H, Kodama Y, Nara S. Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation. Int J Emerg Med 2021; 14:3. [PMID: 33413083 PMCID: PMC7788530 DOI: 10.1186/s12245-020-00322-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retropharyngeal hematoma can cause suffocation if there is delay in securing the airway by intubation. However, there are also concerns about complications that can arise with intubation; it is still unknown which cases do not require intubation. CASE PRESENTATION An 88-year-old woman slipped and was found prone and was transported to the emergency room. She was alert without any stridor. Physical examination revealed a subcutaneous hematoma in the anterior cervical region. Computed tomography revealed a retropharyngeal hematoma. Angiography and computed tomography angiography showed extravasation from the right costocervical trunk. A radiologist performed trans-arterial embolization, and she had an uneventful course without intubation or developing any complication. She became ambulatory on postoperative day 5. CONCLUSION Angiography and computed tomography angiography help in early recognition of extravasation in retropharyngeal hematoma, and trans-arterial embolization can help to avoid intubation and its complications.
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Affiliation(s)
- Gaku Sugiura
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan.
| | - Hiroyuki Takahashi
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Yoshihisa Kodama
- Department of Radiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan
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20
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Miccoli G, La Corte E, Pasquini E, Palandri G. Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review. Surg Neurol Int 2020; 11:124. [PMID: 32494399 PMCID: PMC7265467 DOI: 10.25259/sni_225_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Giovanni Miccoli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini, Naples, Bologna, Italy
| | - Emanuele La Corte
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Department of Neurological Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giorgio Palandri
- Department of Neurological Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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21
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Al Eissa S, Konbaz F, Aldeghaither S, Annaim M, Aljehani R, Alhelal F, Abaalkhail M, Alhandi AA. Anterior Cervical Discectomy and Fusion Complications and Thirty-Day Mortality and Morbidity. Cureus 2020; 12:e7643. [PMID: 32411545 PMCID: PMC7217235 DOI: 10.7759/cureus.7643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is a commonly used procedure. However, few studies reported post-operative complications. This study looks into the prevalence of possible complications and the mortality rate in the first 30 days postoperatively. Methods A retrospective review of patients who underwent ACDF for degenerative disc disease from 2008-2017, in a single center in Riyadh, Saudi Arabia was performed. Patient demographic data, comorbidities, operative notes, immediate and delayed complications were all collected, with a minimum of 30 days follow-up. Results Out of 434 medical charts reviewed, 163 met the inclusion criteria. Mean population age was 52 ± 11 years. Elective cases comprised 90% of sample and most patients had one or two levels operated on, 95% had ACDF and only 5% had corpectomy. The drain was left in 69% of patients and planned intensive care admission was done for 3%. Instrumentation and graft was used, with 92% needing a cage plus plate. Intraoperative complications were minimal. Mean hospital stay was 12.5 ±18 days. Majority of population had no complications in a 30 days period (98.2%). Only one case underwent revision surgery. Conclusions While ACDF is considered a safe procedure, postoperative complications may have long-term implications. This study showed minimal complications in the immediate postoperative period, but due to the limited sample size, a study with larger population is needed to further confirm the results.
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Affiliation(s)
- Sami Al Eissa
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Faisal Konbaz
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Sarah Aldeghaither
- Orthopaedics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Monerah Annaim
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Rayed Aljehani
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Fahad Alhelal
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Majed Abaalkhail
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Ali A Alhandi
- Orthopaedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
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22
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Upper Cervical Surgery, Increased Signal Intensity of the Spinal Cord, and Hypertension as Risk Factors for Dyspnea After Multilevel Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2020; 45:E379-E386. [PMID: 31770331 DOI: 10.1097/brs.0000000000003329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the associated risk factors for acute respiratory distress after multilevel anterior cervical discectomy and fusion (ACDF) with a focus on the subjective symptom, dyspnea. SUMMARY OF BACKGROUND DATA Acute respiratory distress after ACDF is a relatively common adverse event, the cause of which is usually soft tissue swelling or hematoma. It can result in serious morbidity and requires careful, focused treatment. METHODS We reviewed the records of 532 patients (from January 2014 to August 2018) who had undergone multilevel ACDF surgery. Acute respiratory distress was defined as a complaint of dyspnea within 5 postoperative days. We investigated the patients' demographic parameters, comorbidities, and surgical procedure details. We also investigated radiologic parameters, including magnetic resonance imaging (MRI), with special attention to the prevertebral soft tissue thickness at C3 and C6. Statistical analysis was performed using the Student's t test and multiple logistic regression analysis. RESULTS Out of a total of 484 patients studied after exclusion criteria were applied, 31 patients (6.6%) experienced dyspnea after surgery. We selected 92 patients from the non-dyspnea group and compared them with 31 patients from the dyspnea group. On univariate analysis, upper cervical surgery involving C3, increased cord signal intensity on T2-weighted imaging (T2WI) magnetic resonance imaging (MRI), hypertension, smoking, and prevertebral soft tissue swelling at C3 level on postoperative day 1 were statistically significant factors associated with dyspnea. On logistic regression analysis, upper cervical surgery involving C3, increased cord signal intensity on T2WI MRI, and hypertension were found to be statistically significant variables (P < 0.05). CONCLUSION Patients undergoing upper cervical surgery involving C3, and having increased cord signal intensity on T2WI MRI and hypertension need to be monitored more carefully for acute respiratory distress after multilevel ACDF. LEVEL OF EVIDENCE 4.
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23
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Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:302-322. [PMID: 32309668 DOI: 10.21037/jss.2020.01.14] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
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Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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Shousha M, Alhashash M, Allouch H, Boehm H. Reoperation rate after anterior cervical discectomy and fusion using standalone cages in degenerative disease: a study of 2,078 cases. Spine J 2019; 19:2007-2012. [PMID: 31404654 DOI: 10.1016/j.spinee.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Over the last two decades, there has been a rapid increase in the use of cervical spine interbody fusion cages. Reoperation rate remains an important determinant of procedural efficacy and safety. PURPOSE To evaluate the rate and reasons for reoperations in cervical spondylosis patients undergoing anterior decompression and fusion using stand-alone cervical interbody fusion cages. STUDY DESIGN A retrospective study of 2,078 consecutive cases of degenerative cervical spine disease undergoing fusion using stand-alone cages. PATIENT SAMPLE Between January 2005 and December 2014, 2,078 patients underwent anterior cervical decompression and fusion using stand-alone cages in our institution. OUTCOME MEASURES The reoperations were analyzed and classified into early (during the first 90 days postoperatively) and late (after 90 days) reoperations. The rate and the causes of reoperation in both groups were reported and the results were compared. METHODS In 1,558 patients, a short segment fusion (≤2 levels) was performed, while the remaining 520 patients underwent a long segment fusion (≥3 levels). RESULTS The overall incidence of reoperation was 5.63%. The rate of early reoperations was 2.07%, mostly due to postoperative hematoma, and the rate of late reoperations was 3.56%, mostly due to adjacent segment disease. Revision due to pseudarthrosis was performed in 0.58% of cases. The early reoperation rate was significantly higher in the group with a long segment fusion, while the late reoperation rate was significantly higher in patients undergoing a short segment fusion. CONCLUSION Following anterior cervical decompression and fusion with a stand-alone cage, the overall incidence of symptomatic pseudarthrosis is low. Patients undergoing long segment fusion should be closely observed in the early postoperative period as they have a higher early complication rate. On the other hand, long segment fusions have a lower incidence of adjacent segment disease over the years.
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Affiliation(s)
- Mootaz Shousha
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany; Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt.
| | - Mohamed Alhashash
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany; Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
| | - Hassan Allouch
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Heinrich Boehm
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
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Vaishnav A, Hill P, McAnany S, Patel DV, Haws BE, Khechen B, Singh K, Gang CH, Qureshi S. Comparison of Multilevel Anterior Cervical Discectomy and Fusion Performed in an Inpatient Versus Outpatient Setting. Global Spine J 2019; 9:834-842. [PMID: 31819849 PMCID: PMC6882097 DOI: 10.1177/2192568219834894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate differences in patient factors, procedural factors, early outcomes and safety in mutlilevel anterior cervical discectomy and fusion (ACDF) in the inpatient versus outpatient setting. METHODS Patient demographics, operative factors, and outcomes of multilevel ACDF performed in an inpatient and outpatient setting were compared using Fisher's exact test for categorical and Student's t test for continuous variables. RESULTS Fifty-seven patients had surgery on an outpatient and 46 on an inpatient basis. Inpatients were older (56.7 vs 52.2 years, P = .012) and had a higher ASA (American Society of Anesthesiologists) class (P = .002). Sixty percent of 2-level cases were outpatient surgeries, compared with 35% of 3-level cases (P = .042). Outpatients had shorter operative times (71.26 vs 83.59 minutes, P < .0001) and shorter lengths of stay (8.51 vs 35.76 hours, P < .0001), lower blood loss (33.04 vs 45.87 mL, P = .003), and fewer in-hospital complications (5.3% vs 37.0%, P < .0001). Outpatients had better early outcomes in terms of 6-week Neck Disability Index (NDI) (27.97 vs 37.59, P = .014), visual analogue scale (VAS) neck (2.92 vs 4.02, P = .044), and Short Form-12 Physical Health Score (SF-12 PHS) (35.66 vs 30.79, P = .008). However, these differences did not persist at 6 months. CONCLUSIONS The results of our study suggest that multilevel ACDF can be performed safely in the outpatient setting without an increased risk of complications compared with the inpatient setting in an appropriately selected patient. Specifically, patients' age, ASA class, and number of levels being fused should be taken into consideration. At our institution, ASA class 3, body mass index >40 kg/m2, age >80 years, intubation time >2.5 hours, or not having a responsible adult with the patient warrant inpatient admission. Importantly, the setting of the surgery does not affect patient-reported outcomes.
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Affiliation(s)
| | | | - Steven McAnany
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Dil V. Patel
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Kern Singh
- Rush University Medical Center, Chicago, IL, USA
| | | | - Sheeraz Qureshi
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA,Sheeraz Qureshi, Weill Cornell Medical College, 5 East 98th Street, New York, NY 10029, USA.
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Ren H, Wang J, Yu L. Retropharyngeal hematoma following anterior cervical spine surgery: Lessons from a case report (CARE-compliant). Medicine (Baltimore) 2019; 98:e17247. [PMID: 31567991 PMCID: PMC6756692 DOI: 10.1097/md.0000000000017247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Retropharyngeal hematoma (RH) is an infrequent but potentially life-threatening complication of anterior cervical spine surgeries (ACSS). Challenging situations might be confronted and catastrophic events or even deaths still occurred occasionally during the treatment. Currently, no widely accepted protocol has been developed. PATIENT CONCERNS A 55 years old male underwent ACSS due to cervical myelopathy. Thirty-three hours after surgery the patient presented cervical swelling and obstructive dysphagia. Conservative treatment resulted in no recovery and cervical swelling progressed. DIAGNOSES Emergent magnetic resonance imaging and plain radiograph established massive incisional and RHs. RH was shown to extend from the base of the skull to T1. INTERVENTIONS An emergent surgery was performed under local anesthesia and cervical hematoma was evacuated. Nonetheless, evacuation of the blood clots in the vision field resulted into incomplete recovery of throat blockage. A gloved finger was used to explore the retropharyngeal space and some hidden blood clots were found and evacuated, then the patient obtained complete relief of the symptoms. OUTCOMES Normal respiration and swallowing functions were obtained after the surgery. Obviously, recovery of motor function was noted while no other complication was found at 3-month follow-up LESSONS:: Our case illustrated that dysphagia was an early symptom of RH. Posterior compression from RH could cause obstruction of the pharyngeal airway and lead to difficulty of intubation. Hematoma could spread through the retropharyngeal space, a hematoma exploration beyond the visual range might be necessary in some cases for fear of the hidden hematoma.
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Debkowska MP, Butterworth JF, Moore JE, Kang S, Appelbaum EN, Zuelzer WA. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:142-154. [PMID: 31032449 PMCID: PMC6465475 DOI: 10.21037/jss.2019.03.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/20/2019] [Indexed: 12/16/2022]
Abstract
Anterior cervical spine surgery (ACSS) is a common procedure, but not without its own risks and complications. Complications that can cause airway compromise occur infrequently, but can rapidly lead to respiratory arrest, leading to severe morbidity or death. Knowing emergent post-operative airway management including surgical airway placement is critical. We aim to review the different etiologies of post-operative airway compromise following ACSS, the predictable timeline in which they occur, and the most appropriate treatment and management for each. We place special emphasis on the timing and proper surgical technique for an emergent cricothyrotomy. Angioedema is seen the earliest as a cause of post-operative airway compromise, typically within 6-12 hours. Retropharyngeal hematomas can be seen between 6-24 hours, most commonly within 12 hours. Pharyngolaryngeal edema is seen within 24-72 hours. After 72 hours, retropharyngeal abscess is the most likely etiology. Several studies have utilized delayed extubation protocols following ACSS based on patient risk factors and found reduced postoperative airway complications and reintubation rates. The administration of perioperative corticosteroids continues to be controversial with high-level studies recommending both for and against their use. Animal studies showed that after cardiac arrest, the brain can recover if oxygenation is restored within 5 minutes, but this time is likely shorter with asphyxia prior to cardiac arrest. Experience and training are essential to reduce the time for successful cricothyrotomy placement. Physicians must be prepared to diagnose and treat acute postoperative airway complications following ACSS to prevent anoxic brain injury or death. If emergent intubation cannot be accomplished on the first attempt, physicians should not delay placement of a surgical airway such as cricothyrotomy.
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Affiliation(s)
- Monika P. Debkowska
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - John F. Butterworth
- Department of Anesthesiology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Jaime E. Moore
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Soobin Kang
- Department of Radiology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Eric N. Appelbaum
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Wilhelm A. Zuelzer
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
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Improving outcomes in ambulatory anesthesia by identifying high risk patients. Curr Opin Anaesthesiol 2018; 31:659-666. [DOI: 10.1097/aco.0000000000000653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Takeuchi K, Yokoyama T, Numasawa T, Wada KI, Itabashi T, Yamasaki Y, Kudo H, Ota S. Fixed Neck Position in Multilevel Cervical Posterior Decompression and Fusion to Reduce Postoperative Disturbances of Cervical Spine Function. Spine Surg Relat Res 2018; 2:253-262. [PMID: 31435531 PMCID: PMC6690097 DOI: 10.22603/ssrr.2017-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/15/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical posterior spine surgery. The range of motion of the cervical spine decreases markedly after multilevel cervical posterior decompression and fusion (PDF). However, details regarding the limitations of cervical spine function due to postoperative reduced neck mobility after multilevel PDF are as yet unclarified. The present study aimed to clarify the quality of life and its related factors after PDF, and the optimal fixed neck position in multilevel PDF that minimizes the limitations of ADL accompanying markedly reduced postoperative neck mobility. Methods Limitations of ADL involving neck extension, rotation, and flexion were investigated in 32 consecutive patients who underwent C2-T1 PDF using the responses to the cervical spine function domain of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The EuroQol 5 Dimension, Japanese Orthopedic Association score, and five domains of the JOACMEQ were also investigated. We investigated the risk factors regarding the fixed neck position in PDF for the impossibility to perform ADL involving each of three movements using cut-off values obtained from receiver-operating characteristic curves. Results Postoperative comprehensive quality of life was significantly related to neurological improvements and to poor outcomes of cervical spine function after PDF. The significant risk factors for impossibility to perform ADL involving neck rotation were a C2-C7 lordotic angle ≥ 6° (P = 0.0057) or a proportion coefficient of C2-T1 tilt angle/C2-C7 lordotic angle ≤ 1.8 (P = 0.0024). There were no significant risk factors for impossibility to perform ADL involving neck extension or flexion. Conclusions The optimal fixed neck position in C2-T1 PDF to reduce postoperative limitations of ADL involving neck mobility is a C2-C7 lordotic angle of less than 6°, or a C2-T1 tilt angle (°) of greater than 1.8 × the C2-C7 lordotic angle (°).
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Takuya Numasawa
- Department of Orthopedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Towada, Japan
| | | | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
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