Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position

Case report.

To stress the importance of the fusion angle of the occipitocervical spine based on an unusual case of upper-airway obstruction after a posterior fusion from the occipital bone to the second cervical vertebra (O-C2) in a flexed position.

It is well known that cervical malalignment after occipito-cervicothoracic fusion may cause dysphagia or, rarely, dyspnea. However, to the best of our knowledge, there have been no previous English reports of prolonged upper-airway obstruction after an O-C2 fusion.

We present the case of a 77-year-old woman with rheumatoid arthritis, who developed an upper-airway obstruction immediately after an O-C2 fusion. She was reintubated immediately and extubated the next day. She again suffocated suddenly 3 days after surgery, and a tracheotomy was performed. Suspecting that the main cause of the airway obstruction was not only pharyngeal edema, but also the fixture of the upper cervical angle in a flexed position, we changed the angle to the neutral position 14 days after surgery.

After revision surgery, the upper-airway obstruction disappeared.

An adequate fixation angle is necessary to avoid airway obstruction after an occipitocervical fusion, even for short upper cervical fusions, especially in patients with rheumatoid arthritis.