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


BACKGROUND
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.


CONCLUSIONS
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.
Yoshida
Makoto
M
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Neo
Masashi
M
Fujibayashi
Shunsuke
S
Nakamura
Takashi
T
D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004417:Dyspnea / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011187:Posture; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed