Tracheostomy after anterior cervical spine fixation

Area of Science:

• Neurosurgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Cervical spine injuries often necessitate anterior cervical spine fusion and tracheostomy, especially with concurrent spinal cord injury (SCI).
• The proximity of surgical sites raises concerns, but safety of post-fixation tracheostomy was hypothesized.
• Motor deficit severity in cervical spine injury was postulated to correlate with tracheostomy requirement.

Purpose of the Study:

• To evaluate the safety of performing tracheostomy after anterior cervical spine fixation.
• To determine if the severity of motor deficits in cervical spine injury correlates with the need for tracheostomy.

Main Methods:

• Retrospective review of adult trauma patients with cervical spine fractures or SCI from 1996-2001.
• Data collected included demographics, American Spinal Injury Association (ASIA) impairment scale, complications, and tracheostomy use.
• Chi-squared analysis was used for categorical data, with p < 0.05 considered significant.

Main Results:

• 45% of SCI patients and 14% of non-SCI patients underwent tracheostomy (p < 0.001).
• Tracheostomy rates increased with injury severity: 76% for ASIA A/B, 38% for ASIA C, 23% for ASIA D.
• In patients undergoing both procedures (n=17), tracheostomy occurred a median of 7 days post-fixation; 71% were percutaneous with no wound infections or nonunions.

Conclusions:

• Tracheostomy is safe 6-10 days after anterior cervical spine fixation, particularly in cervical SCI patients.
• Severe motor deficits are strongly associated with tracheostomy use in cervical spine injury.
• Percutaneous tracheostomy is preferred due to minimal wound creation; further study on optimal timing and use is needed.