CATASTROPHIC AIRWAY COMPLICATIONS STATUS POST ANTERIOR CERVICAL DISCECTOMY AND FUSION

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Anterior cervical discectomy and fusion is a commonly performed spine surgery and considered a relatively safe procedure. It usually carries a small risk of postoperative complications, however, airway compromise after cervical spine surgery can be catastrophic and one that all providers should be aware of. Here we present a case of catastrophic airway complication status post anterior cervical discectomy and fusion. CASE PRESENTATION: We present a 75 year-old female with long history of C2 fracture with anterior displacement secondary to fall with intermittent left arm numbness and weakness who presented for a scheduled C3/4/5 Anterior Cervical Discectomy and Fusion. Patient had a prolonged surgical fixation resulting in prolonged duration of time in the prone position. The patient had significant facial and upper airway swelling and was therefore not extubated postop due to the concerns of the above mentioned swelling. The following morning, the swelling improved and the patient was extubated with no complications. Postop day 2, the patient developed stridor which did not respond to dexamethasone or racemic epinephrine. The neck swelling quickly worsened and fiberoptic intubation was planned. The patient was found to have an edematous larynx with difficulty passing the endotracheal tube through the vocal cords. The patient was noted to desaturate and subsequently became pulseless; CPR was initiated. Emergent crychothyroidotomy which was successfully performed however patient's end tidal and oxygen saturations remained flat. Bedside echo showed no cardiac activity and the patient unfortunately did not obtain ROSC. DISCUSSION: Anterior cervical discectomy and fusion is considered a relatively safe procedure, but can be related to catastrophic complications. Airway compromise requiring reintubation are rare, but have never been quantified. Potential causes of airway obstruction include pharyngeal edema, hematoma, cerebrospinal fluid leak and angioedema. Risk factors for airway complication include prolonged anesthetic time, extensive cervical dissections above C4 and estimated blood loss greater than 300 mL. The average time to respiratory insufficiency in these patients is 23 hours after surgery. Therefore, we suggest that intensive observation of respiratory function should be monitored for at least 48 hours following an anterior cervical discectomy and fusion procedure. CONCLUSIONS: This case shows that airway complications following anterior cervical discectomy and fusion can be catastrophic. This is a complication that all Pulmonary Critical Care physicians should be aware of. The above mentioned risk factors should be checked and intense observation of respiratory function should be monitored for at least 48 hours after surgery. Reference #1: Lim, S., Kesavabhotla, K., Cybulski, G. R., Dahdaleh, N. S., & Smith, Z. A. (2017). Predictors for Airway Complications Following Single- and Multilevel Anterior Cervical Discectomy and Fusion. Spine, 42(6), 379-384. Reference #2: Sagi, H. C., Beutler, W., Carroll, E., & Connolly, P. J. (2002). Airway Complications Associated With Surgery on the Anterior Cervical Spine. Spine, 27(9), 949-953 DISCLOSURES: No relevant relationships by Armand Golchin, source=Web Response No relevant relationships by William McGee, source=Web Response No relevant relationships by Mitchell Onwochei-Ashei, source=Web Response No relevant relationships by Quazi Kamran Uddin, source=Web Response