title: Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshida
authors.forename: Masashi
authors.initials: M
authors.lastname: Neo
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fujibayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
mesh_terms: 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