International Orthopaedics

, Volume 30, Issue 4, pp 290–294 | Cite as

Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation

Original Paper

Abstract

Airway complications after anterior cervical surgery are rare but potentially lethal. The purpose of this study was to identify the natural course of prevertebral soft tissue swelling after one- or two-level anterior cervical discectomy and fusion (ACDF) in order to prevent lethal airway obstruction after ACDF. Eighty-seven patients scheduled for one- or two-level ACDF were studied prospectively. Lateral radiographs of the cervical spine were taken preoperatively, postoperatively on the day of surgery and on the first, second, third, fourth, and fifth days after operation. Prevertebral soft tissue was measured from C2 to C6 on cervical spine lateral radiographs. The anteroposterior (AP) thickness of the prevertebral soft tissue was measured at each cervical level from C2 to C6. Prevertebral soft tissue swelling occurred postoperatively and increased markedly on the second day after operation. The maximum swelling was found on the second and third days. In fusions above C5 swelling was most prominent at C2, 3. Gradual decrease in swelling was observed after the fourth postoperative day. Prominent swelling was noted at the second, third, and fourth cervical levels. There was no significant difference in swelling when comparing one-level and two-level ACDF. Only one patient required reintubation (1.1%). In conclusion, in this prospective study of 87 patients fused at one or two levels in the cervical spine peak prevertebral soft tissue swelling was observed on the second and third days after the surgery.

Résumé

Les complications aériennes après chirurgie cervicale antérieure sont rares mais potentiellement léthales. Le sujet de ce travail est d’étudier l’évolution de l’œdème prévertébral après discectomie antérieure et fusion à un ou deux niveaux ( ACDF) pour prévenir une obstruction aérienne. 87 patients devant avoir un ACDF a un ou deux niveaux étaient étudiés prospectivement. Des radiographies de profil de la colonne cervicale ont été faites avant l’opération, après l’opération le jour de la chirurgie, puis les premier, deuxième, troisième, quatrième et cinquième jours après. Les parties molles prévertébrales étaient mesurées de C2 à C6 sur ces radiographies. L’œdème prévertébral apparaissait en postopératoire et avait une augmentation marqué le deuxième jour après la chirurgie. Dans les fusions au-dessus de C5 l’œdème prédominait en C2, C3. La régression de l’œdème était observée après le quatrième jour post-opératoire. Un œdème prononcé était noté aux deuxième, troisième et quatrième niveau cervical. Il n’y avait pas de différence significative dans l’oedème en comparant un et deux niveaux de discectomie-fusion. Seulement 1 patient a eu besoin d’une ré-intubation (1,1%). En conclusion , dans cette série, l’acmé de l’œdème prévertébral était observée les deuxième et troisième jours après l’opération.

References

  1. 1.
    Arimune M, Sanjou H, Yamada T, Yabe M, Miyake H (2004) Minitracheostomy in treating upper airway obstruction after anterior cervical fusion. Masui 53(10):1193–1196PubMedGoogle Scholar
  2. 2.
    Chang HS, Kondo S, Mizuno J, Nakagawa H (2004) Airway obstruction caused by cerebrospinal fluid leakage after anterior cervical spine surgery. A report of two cases. J Bone Joint Surg Am 86:370–372PubMedGoogle Scholar
  3. 3.
    Coe JD, Vaccaro AR (2005) Complications of anterior cervical plating. In: Clark CR (ed) The cervical spine. Lippincott Williams & Wilkins, Philadelphia, PA, pp 1163–1164Google Scholar
  4. 4.
    DeBehnke DJ, Havel CJ (1994) Utility of prevertebral soft tissue measurements in identifying patients with cervical fracture. Ann Emerg Med 24(6):1119–1124PubMedCrossRefGoogle Scholar
  5. 5.
    Emery SE, Smith MD, Bohlman HH (1991) Upper-airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg Am 73:544–551PubMedGoogle Scholar
  6. 6.
    Epstein NE, Hollingsworth R, Nardi D et al (2001) Can airway complications following multilevel anterior cervical surgery be avoided? J Neurosurg 94(2s):185–188PubMedGoogle Scholar
  7. 7.
    Fujiwara H, Nakayama H, Takahashi H et al (1998) Postoperative respiratory disturbance after anterior cervical fusion. Masui 47(4):475–478PubMedGoogle Scholar
  8. 8.
    Harris OA, Runnels JB, Matz PG (2001) Clinical factors associated with unexpected critical care management and prolonged hospitalization after elective cervical spine surgery. Crit Care Med 29:1889–1902CrossRefGoogle Scholar
  9. 9.
    Krnacik MJ, Heggeness MH (1997) Severe angioedema causing airway obstruction after anterior cervical surgery. Spine 22(18):2188–2190CrossRefPubMedGoogle Scholar
  10. 10.
    Penberthy A, Roberts N (1998) Recurrent acute upper airway obstruction after anterior cervical fusion. Anesth Intensive Care 26(3):305–307Google Scholar
  11. 11.
    Riew KD, Won DS, DellaRocca GJ (2001) Parameters for maintaining intubation postoperative following anterior cervical procedures. Paper presented at the Cervical Spine Research Society 29th Annual Meeting 2001, Monterey, CAGoogle Scholar
  12. 12.
    Sagi HC, Beutler W, Carroll E (2002) Airway complications associated with surgery on the anterior cervical spine. Spine 27(9):949–953CrossRefPubMedGoogle Scholar
  13. 13.
    Uppal GS, Akmakjian J (1999) Outpatient cervical spine fusions. Abstract book of 1fourth Annual Meeting of North American Spine Society, p 158Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, College of MedicineKyung Hee UniversitySeoulSouth Korea

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