J Korean Soc Spine Surg.  2013 Dec;20(4):190-195. 10.4184/jkss.2013.20.4.190.

Acute Myocardial Infarction and Postpharyngeal Hematoma after Anterior Cervical Spine Surgery on a Coronary Artery Disease Patient: A Case Report

• Kim JE
• Kang YJ
• Park SW
• Kim KS
• Lee DK
• Suk KS

• KMID: 1896949
• DOI: http://doi.org/10.4184/jkss.2013.20.4.190

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report a case of preventive intubation to coronary artery disease patient who underwent percutaneous coronary intervention following an anterior cervical spine surgery. SUMMARY OF LITERATURE REVIEW: Postpharyngeal hematoma occurs more to a patient who underwent percutaneous coronary intervention for myocardial infarction following an anterior cervical spine surgery. And postoperative airway obstruction due to it is one of the most serious adverse events associated with anterior cervical spine surgery. Preventive intubation was tried and it was useful for treatment.
MATERIALS AND METHODS
A 61-year-old man suffered from neck pain and radiating pain on left upper extremity was performed an anterior cervical spine surgery. After operation, he complained acute myocardial infarction symptoms and Emergency percutaneous coronary intervention was performed. After that, postpharyngeal hematoma appeared and compressed the airway. Intubation was performed to prevent airway obstruction. RESULT: Airway obstruction was prevented through early intubation. Hematoma evacuation and insertion of Hemovac performed and the patient discharged without any complications such as neurologic or cardiac problems.
CONCLUSION
Preventive intubation to coronary artery disease patient who underwent percutaneous coronary intervention following an anterior cervical spine surgery is useful for treatment of airway obstruction due to postpharyngeal hematoma.

Keyword

Anterior cervical spine surgery; Coronary artery disease; Postpharyngeal hematoma; Airway obstruction

MeSH Terms

Airway Obstruction
Coronary Artery Disease*
Coronary Vessels*
Emergencies
Hematoma*
Humans
Intubation
Middle Aged
Myocardial Infarction*
Neck Pain
Percutaneous Coronary Intervention
Spine*
Upper Extremity

Figure

• 

  Fig. 1. preoperative serial x-rays

• 

  Fig. 2. postoperative serial x-rays (post op 1day 07:00)

• 

  Fig. 3. postoperative serial x-rays (post op 2day 07:00)

• 

  Fig. 4. postoperative serial x-rays (post op 3day 13:00)

• 

  Fig. 5. postoperative serial x-rays (post op 3day 19:00)

• 

  Fig. 6. Serial CT images preoperative CT scan shows patent airway (arrow)

• 

  Fig. 7. Serial CT images postoperative CT scan shows narrow airway sus-tained by a reinforced tube (arrow)

Reference

1. Emery SE, Bohlman HH, Bolesta MJ, Jones PK. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy -Two to seventeen-year followup. J Bone Joint Surg Am. 1998; 80:941–51.

2. Marotta N, Landi A, Tarantino R, Mancarella C, Rug-geri A, Delfini R. Five-year outcome of stand-alone fusion using carbon cages in cervical disc arthrosis. Eur Spine J. 2011; 20:S8–12.

3. Mcafee PC, Bohlman HH, Riley LH, Robinson RA, South-wick W0, Nachlas NE. The Anterior Retropharyngeal Approach to the Upper Part of the Cervical Spine. J Bone Joint Surg Am. 1987; 69:1371–83.

4. Suk KS, KIM KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop. 2006; 30:290–4.

5. Levelle JP, Martinez OA. Airway obstruction after bilateral carotid endarterectomy. Anesthesiology. 1985; 63:220–2.

6. Yu NH, Jahng TA, Kim CH, Chung CK. Life-threatening late hemorrhage due to superior thyroid artery dissection after anterior cervical discectomy and fusion. Spine(Phila Pa 1976). 2010; 35:E739–42.

7. Sethi R, Tandon M, Ganjoo P. Neck hematoma causing acute airway and hemodynamic compromise after anterior cervical spine surgery. J Neurosurg Anesthesiol. 2008; 20:69–70.

8. Boyce JR, Peters GE. Complete vasomotor collapse: an un-usual manifestation of the carotid sinus reflex. Anesthesiology. 2003; 98:1285–7.

9. Mark A. Palumbo, Jessica Pelow Aidlen, Alan H. Daniels, Nikhil A. Thakur and Joseph Caiati. Airway compromise due to wound hematoma following anterior cervical spine surgery. Open Orthop J. 2012; 45:108–13.

10. Bukht D, Langford RM. Airway obstruction after surgery in the neck. Anaesthesia. 1983; 38:389–90.

11. Edward T, Crosby MD. Considerations for airway management for cervical spine surgery in adults. Department of Anesthesiology Clinics. 2007; 25:511–33.