Spontaneous contralateral pneumothorax: a rare but potential complication of anterior cervical total disk...

Anterior cervical discectomy and fusion (ACDF) surgery is a treatment for cervical disk herniation, a condition that may contribute to compression upon the spinal cord or the exiting nerve roots. The primary goals of this surgery are to decompress the neurological structures while stabilizing segments that are either unstable intrinsically or unstable by way of decompression. More recently, total disk arthroplasty (TDA) and anterior decompression has been introduced as an alternative to ACDF. Pneumothorax is caused by air filling the pleural cavity between the parietal pleura and the lung, causing the lung to collapse from the loss of negative pressure in that space, impairing lung function. The development of pneumothorax is a rare event during anterior approaches to the cervical spine, but the authors are not aware of the development during surgery of a pneumothorax contralateral to the side of approach.

A 27-year-old female patient with cervical disc disease associated with C5-C6 and C6-C7. The patient has a history of smoking, an incomplete right bundle branch block, postural orthostatic tachycardia syndrome, premature ventricular contraction, and fibromyalgia, presented to the operating room for anterior decompression and TDA of C5-C6 and C6-C7 for cervical disk disease. There was no history of soft tissue disease.

During anterior cervical spine surgery, contralateral pneumothorax can occur. This may happen due to the 30-degree positioning, positive pressure ventilation with positive end-expiratory pressure/continuous positive airway pressure, and potential pressure differential separating the tracheoesophageal complex from the pre-vertebral potential space. There are no current preventative measures for pneumothorax during anterior cervical spine surgery with standard techniques, but it is important not to dismiss the condition based solely on initial negative imaging results. Spontaneous contralateral pneumothorax is not commonly recognized as a complication of anterior cervical spine surgery; however, physicians should be aware of the possibility of its occurrence.