Research Article: Prolonged Airway Obstruction after Posterior Occipitocervical Fusion: A Case Report and Literature Review

Date Published: June 30, 2011

Publisher: SAGE-Hindawi Access to Research

Author(s): Masahiro Morita, Masuhiro Nobuta, Hirotsune Naruse, Hiroaki Nakamura.


The purpose of this paper was to inform the reader that prolonged upper airway obstruction after posterior cervical spine surgery is a possible complication for patients with metastatic tumor of upper cervical spine. A 49-year-old man presented severe neck pain during posture changes due to metastatic spinal tumor of C2. Occipitocervical fusion following removal of the posterior arch of C1 and laminectomy of C2 via the single posterior approach was performed 2 weeks after radiation therapy. After the surgery, life-threatening airway obstruction due to pharyngeal oedema occurred immediately after extubation that required emergency tracheostomy. The airway obstruction did not improve well during the patient’s postoperative course. Once pharyngeal oedema occurs in patients with metastatic tumor of upper cervical spine who undergo posterior cervical spine surgery following radiation therapy to the neck, the pharyngeal oedema may be constant for a long period of time.

Partial Text

Airway obstruction is a well-recognized complication after neck surgery, including cervical spine surgery. The airway obstruction related to neck surgery could occur due to wound haematoma, pharyngeal oedema, graft dislodgment, asthma, and other causes [1].

A 49-year-old man was referred to our hospital with a four-month history of severe neck pain during posture changes, as well as mild paresthesia in his left arm. Because of his severe neck pain, he could not walk or remain standing or sitting. He had undergone surgery, and chemotherapy for gastric cancer 19 months previously. Metastases to the left adrenal gland and diaphysis of the right femur were diagnosed after he received chemotherapy. Physical examination was normal except for exaggerated deep tendon reflexes in his upper and lower extremities.

The reported rate of postoperative airway obstruction following cervical spine surgery varies in the English literature. Sagi et al. [1] reported a rate of 4.2% (13/311) for postoperative reintubation after surgery on the anterior cervical spine. Wattenmaker et al. [6] reported a rate of 7.8% (10/128) for postoperative airway obstruction and 3.9% (5/128) for reintubation among patients with rheumatoid arthritis undergoing posterior cervical spine surgery.




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