Yamada Kentaro, Yoshii Toshitaka, Hirai Takashi, Kudo Atsushi, Nosaka Nobuyuki, Egawa Satoru, Matsukura Yu, Inose Hiroyuki, Okawa Atsushi
Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Department of Orthopaedics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
J Orthop Sci. 2025 Mar;30(2):259-266. doi: 10.1016/j.jos.2024.03.011. Epub 2024 Apr 4.
Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients' symptoms to prevent unfavorable outcomes.
An extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded.
Twenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes.
The early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.
颈椎前路手术后的气道梗阻可能是一种致命并发症。偶尔，它会迅速进展为完全梗阻。对于医护人员在颈椎前路手术后如何评估体征和症状、寻求帮助或促进气道管理以预防不良事件，目前尚无既定的标准化方案。本研究旨在主要描述一种系统方法，通过评估接受颈椎前路手术患者气道受损的体征和治疗结果。此外，根据患者症状为医护人员推荐拔管后的行动方案，以预防不良后果。
在PubMed、科学网和考克兰图书馆进行了广泛的文献检索，以识别仅限于英文且发表于1990年1月至2023年3月之间的病例报告、病例系列和队列研究。我们纳入了描述颈椎前路手术后气道梗阻体征、症状和治疗的病例。同时，排除了涉及其他已知原因并发症的病例、创伤或枕颈固定病例，或使用骨形态发生蛋白的病例。
从17项研究中获得了20例病例，其研究质量可接受。4例患者死亡，2例出现缺氧缺血性脑病。此外，6例患者中有5例出现致命并发症，最初在术后7小时内发生。然后，13例有血肿证据的患者中有9例（69%）在术后12小时内出现初始症状。最后，11例有早期症状的患者中有9例预后良好，而出现晚期症状的患者通常预后不良。
早期识别体征和症状并立即治疗很重要，尤其是在术后12小时内。我们根据症状紧急程度为医护人员建议了一种新的行动方案，包括用绳子测量颈围以评估颈部肿胀。
