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Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position

STUDY DESIGN: Case report. OBJECTIVE: To stress the importance of the fusion angle of the occipitocervical spine based on an unusual case of upper-airway obstruction after a posterior fusion from the occipital bone to the second cervical vertebra (O-C2) in a flexed position. SUMMARY OF BACKGROUND DATA: It is well known that cervical malalignment after occipito-cervicothoracic fusion may cause dysphagia or, rarely, dyspnea. However, to the best of our knowledge, there have been no previous English reports of prolonged upper-airway obstruction after an O-C2 fusion. METHODS: We present the case of a 77-year-old woman with rheumatoid arthritis, who developed an upper-airway obstruction immediately after an O-C2 fusion. She was reintubated immediately and extubated the next day. She again suffocated suddenly 3 days after surgery, and a tracheotomy was performed. Suspecting that the main cause of the airway obstruction was not only pharyngeal edema, but also the fixture of the upper cervical angle in a flexed position, we changed the angle to the neutral position 14 days after surgery. RESULTS: After revision surgery, the upper-airway obstruction disappeared. CONCLUSION: An adequate fixation angle is necessary to avoid airway obstruction after an occipitocervical fusion, even for short upper cervical fusions, especially in patients with rheumatoid arthritis

Keywords : adverse effects,Aged,Airway Obstruction,Arthritis,Rheumatoid,Axis,Cervical Vertebra,Deglutition Disorders,diagnostic imaging,Dyspnea,Edema,etiology,Female,Humans,methods,Occipital Bone,Patients,Postoperative Complications,Posture,Reoperation,Spinal Fusion,Spine,surgery,Tomography,X-Ray Computed,Tracheotomy,Universities,, Obstruction,After,Short,Posterior,Occipitocervical, mri scan neck

Date of Publication : 2007 Apr 15

Authors : Yoshida M;Neo M;Fujibayashi S;Nakamura T;

Organisation : Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/17426623

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