Management and Treatment Algorithm of Airway Complications After Anterior Cervical Spine Surgery: Systematic Review

Overview

Journal J Spine Surg

Date 2024 Oct 14

PMID 39399087

Authors

Luis Felipe Colon

Lauren Barber

Ellen Soffin

Todd J Albert

Yoshihiro Katsuura

Affiliations

Soon will be listed here.

Abstract

Background: Airway-related complications are rare after cervical spine surgery but can be devastating and compromise a successful outcome. The objective of this systematic review is to provide an overview of the management of airway complications after anterior cervical spine surgery (ACSS) and propose a treatment algorithm for approaching the patient with a compromised airway.

Methods: A literature search was conducted in PubMed and adapted for use in other databases, including the Cochrane Register of Controlled Trials, Cochrane Library Health Technology Assessment Database, Embase, and the National Health Service (NHS) Economic Evaluation Database.

Results: A total of 117 papers received a full text review. Thirty-seven studies were categorized as "management" and included. An additional four references were extracted from other references for a total of 41 studies.

Conclusions: Most of the available evidence on airway compromise after ACSS is level III or IV. Similarly, most available evidence on the management of acute airway complications comes from case reports or anecdotal publications. There are currently no methods in place to stratify the risk of airway complications in patients undergoing these guidelines on the management of these complications when they occur. This review is focused on practice, including management of such complications with a proposed treatment algorithm.

References

Bonhomme V, Hans P . Management of the unstable cervical spine: elective versus emergent cases. Curr Opin Anaesthesiol. 2009; 22(5):579-85. DOI: 10.1097/ACO.0b013e32832e7adb. View

Inoue S, Fujimoto Y, Kawano Y, Furuya H . Difficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma--a case report. Middle East J Anaesthesiol. 2011; 21(1):125-7. View

Chang D, Park J, Kim H, Park S . Delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture: a case report. Eur J Med Res. 2021; 26(1):77. PMC: 8290576. DOI: 10.1186/s40001-021-00550-6. View

Bruck S, Trautner H, Wolff A, Hain J, Mols G, Pakos P . Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation. Anaesthesia. 2014; 70(2):160-5. DOI: 10.1111/anae.12858. View

Schoenhage K, Koenig H . Unanticipated difficult endotracheal intubations in patients with cervical spine instrumentation. Anesth Analg. 2006; 102(3):960-3. DOI: 10.1213/01.ane.0000194446.18696.eb. View

Bribriesco A, Patterson G . Cricothyroid Approach for Emergency Access to the Airway. Thorac Surg Clin. 2018; 28(3):435-440. DOI: 10.1016/j.thorsurg.2018.04.009. View

Eskander A, de Almeida J, Irish J . Acute Upper Airway Obstruction. N Engl J Med. 2019; 381(20):1940-1949. DOI: 10.1056/NEJMra1811697. View

Kim M, Choi I, Park J, Jeon S, Rhim S, Roh S . Airway Management Protocol After Anterior Cervical Spine Surgery: Analysis of the Results of Risk Factors Associated With Airway Complication. Spine (Phila Pa 1976). 2017; 42(18):E1058-E1066. DOI: 10.1097/BRS.0000000000002236. View

Manski T, Wood M, DUNSKER S . Bilateral vocal cord paralysis following anterior cervical discectomy and fusion. Case report. J Neurosurg. 1998; 89(5):839-43. DOI: 10.3171/jns.1998.89.5.0839. View

10.

Hans P, Marechal H, Bonhomme V . Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery. Br J Anaesth. 2008; 101(5):731-7. DOI: 10.1093/bja/aen271. View

11.

Thompson C, Moga R, Crosby E . Failed videolaryngoscope intubation in a patient with diffuse idiopathic skeletal hyperostosis and spinal cord injury. Can J Anaesth. 2010; 57(7):679-82. DOI: 10.1007/s12630-010-9313-5. View

12.

Riew K, Sethi N, Devney J, Goette K, Choi K . Complications of buttress plate stabilization of cervical corpectomy. Spine (Phila Pa 1976). 1999; 24(22):2404-10. DOI: 10.1097/00007632-199911150-00019. View

13.

Debkowska M, Butterworth J, Moore J, Kang S, Appelbaum E, Zuelzer W . Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. J Spine Surg. 2019; 5(1):142-154. PMC: 6465475. DOI: 10.21037/jss.2019.03.01. View

14.

Song K, Choi B, Lee D, Lim D, Oh S, Kim S . Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis. J Orthop Surg Res. 2017; 12(1):19. PMC: 5270356. DOI: 10.1186/s13018-017-0517-z. View

15.

Manninen P, Jose G, Lukitto K, Venkatraghavan L, El Beheiry H . Management of the airway in patients undergoing cervical spine surgery. J Neurosurg Anesthesiol. 2007; 19(3):190-4. DOI: 10.1097/ANA.0b013e318060d270. View

16.

Levine A, DeMaria Jr S . An updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway: where is the aspiration risk assessment?. Anesthesiology. 2013; 119(3):731-2. DOI: 10.1097/ALN.0b013e31829e4b42. View

17.

Cohn A, Zornow M . Awake endotracheal intubation in patients with cervical spine disease: a comparison of the Bullard laryngoscope and the fiberoptic bronchoscope. Anesth Analg. 1995; 81(6):1283-6. DOI: 10.1097/00000539-199512000-00027. View

18.

Palumbo M, Aidlen J, Daniels A, Bianco A, Caiati J . Airway compromise due to laryngopharyngeal edema after anterior cervical spine surgery. J Clin Anesth. 2012; 25(1):66-72. DOI: 10.1016/j.jclinane.2012.06.008. View

19.

Jung A, Schramm J . How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study. Neurosurgery. 2010; 67(1):10-5. DOI: 10.1227/01.NEU.0000370203.26164.24. View

20.

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View