Nagoshi Narihito, Matsubayashi Kohei, Tsuji Osahiko, Ozaki Masahiro, Suzuki Satoshi, Okubo Toshiki, Takeda Kazuki, Nagata Hiromasa, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
Spine Surg Relat Res. 2024 Dec 10;9(3):300-306. doi: 10.22603/ssrr.2024-0182. eCollection 2025 May 27.
Surgical interventions for cervical spine and spinal cord diseases may lead to life-threatening postoperative airway obstruction, requiring urgent airway management. This study aimed to assess the feasibility and effectiveness of our respiratory management protocol for patients undergoing anterior cervical approaches, posterior occipitocervical fusion, and intramedullary tumor resection.
This single-center retrospective study consisted of 497 patients who underwent cervical surgeries, including anterior fusion, posterior occipitocervical fusion, combined anterior and posterior fusions, and intramedullary tumor resection between January 2006 and June 2022. Our institution implemented a specific postoperative airway management protocol from September 2014 onward. The protocol involved continued intubation for at least the first postoperative night, followed by a spontaneous breathing trial with a cuff leak test and extubation one or more days after surgery. We compared the outcomes between the pre-protocol period (non-protocol group, n=234) and the protocol period (protocol group, n=263).
There were no significant between-group differences regarding demographic, clinical, or surgical details. In the non-protocol group, four subjects required reintubation because of postoperative airway complications (anterior fusion: 1 patient, posterior occipitocervical fusion: 1 patient, and intramedullary tumor resection: 2 patients). After the airway protocol implementation, the reintubation rate dropped to zero (=0.048).
Our airway management protocol substantially reduced the need for reintubation. These findings emphasize the importance of postoperative respiratory management after cervical spine surgeries and underscore the need for appropriate measures to prevent complications.
颈椎和脊髓疾病的外科手术干预可能导致危及生命的术后气道梗阻，需要紧急气道管理。本研究旨在评估我们的呼吸管理方案对接受颈椎前路手术、枕颈后路融合术和髓内肿瘤切除术患者的可行性和有效性。
这项单中心回顾性研究纳入了2006年1月至2022年6月期间接受颈椎手术的497例患者，包括前路融合术、枕颈后路融合术、前后联合融合术和髓内肿瘤切除术。我们的机构从2014年9月起实施了特定的术后气道管理方案。该方案包括术后至少第一晚持续插管，随后进行带有套囊漏气试验的自主呼吸试验，并在术后一天或多天后拔管。我们比较了方案实施前时期（非方案组，n = 234）和方案实施时期（方案组，n = 263）的结果。
在人口统计学、临床或手术细节方面，两组之间没有显著差异。在非方案组中，有4名患者因术后气道并发症需要再次插管（前路融合术：1例患者，枕颈后路融合术：1例患者，髓内肿瘤切除术：2例患者）。气道方案实施后，再次插管率降至零（= 0.048）。
我们的气道管理方案显著降低了再次插管的需求。这些发现强调了颈椎手术后术后呼吸管理的重要性，并强调了采取适当措施预防并发症的必要性。
