Tracheal laceration associated with cervical spine injury-case report

Mortality as a result of cervical spine injuries is predominantly associated with respiratory complications. Besides atelectasis, pneumonia, or respiratory failure, possible complications also include damage to anatomical structures of the respiratory tract.

We present the case of a 44-year-old man who suffered a cervical spine injury with associated tracheal laceration after a fall from a height of about 2 meters. Vertebrae C3, C4, C5 were damaged with anterior dislocation at the C3/C4 level. Because of the development of respiratory failure, the patient was intubated and mechanical ventilation was commenced. In view of a complete and irreversible spinal cord injury, the patient was not qualified for an emergency stabilisation of the vertebral fractures. Surgery was further delayed because of increasing signs of a respiratory infection. On the 12th ICU day, a perforation of the anterior tracheal wall was identified during an elective tracheotomy. Due to the presence of pus at the tracheostomy site and air leakage around the tracheostomy tube cuff, the patient was intubated with a double-lumen endotracheal tube. On the 23th ICU day, acute problems with mechanical ventilation developed due to persisting air leakage around the tube cuff accompanied by signs suggestive of a tracheo-oesophageal fistula. Replacement of the double-lumen tube with a single-lumen one and a bronchoscopy was followed by cardiac arrest. Resuscitation led to the return of circulation over four hours, followed by death of the patient in the setting of increasing shock. The cervical spine injury suffered by the patient can be classified as Magerl's B1.2.3 and additionally as a Category C injury. These are the most severe injuries which may be accompanied by tracheal or oesophageal damage. In such cases, it is advisable to carry out detailed work-up to detect any damage to structures adjacent to the spine, in particular the trachea and oesophagus. Early stabilisation of severe spinal fractures allows for intraoperative assessment of the adjacent structures. A delay in diagnosing damage to the trachea or oesophagus is associated with poorer prognosis and a potential inability to treat the injuries due to developing inflammatory complications.