INTRODUCTION

Anterior cervical discectomy and fusion (ACDF) is a commonly performed neurological procedure, for treating cervical spine pathologies such as cervical disc herniation. Despite the desirable results, it may cause serious, life threatening complications include pneumothorax, pneumomediastinum, and subcutaneous emphysema, which happen duo to iatrogenic injury to trachea, esophagus, or Hypopharynx. Spontaneous cases are particularly unusual.

PRESENTATION OF CASE

In this report we describe a case of spontaneous Subcutaneous emphysema (SE) following ACDF. A 69-year-old female patient, with free past medical history, underwent ACDF to treat a C4-C5-C6 disc protrusion. On the second day After the surgery, she complained of facial swelling, vomiting, and a cough, and on examination crepitus was found. A CT scan show pneumomediastinum and massive subcutaneous emphysema on the right side, extending to the chest and posterior scapula. Then the patient was treated with oxygen, IV antibiotics, and antifungals in the ICU. 48 h later, her condition stabilized, then she was transferred to the surgical ward. The patient recovered well and was discharge with good condition five day postoperative.

DISCUSSION

Subcutaneous emphysema can happen spontaneously or after surgery, often resolving without intervention. It is classified into grades according to severity, and in this case, it was graded 4. Radiological imaging, including CT, was important for diagnosis. Treatment focuses primarily on supportive care, and more severe cases may require invasive intervention.

CONCLUSION

This case demonstrates that although spontaneous subcutaneous emphysema after ACDF is rare, with early diagnosis and ideal treatment, patients can be cured without major intervention.