Airway Complications After Cervical Spine Surgery: A Focused Review on Recent Evidence and Perioperative Management

Airway complications after cervical spine surgery are infrequent but potentially catastrophic. The mechanisms of postoperative airway compromise differ according to surgical approach, extent of surgery, and underlying cervical pathology and include prevertebral and airway soft-tissue edema, retropharyngeal hematoma, recurrent laryngeal nerve dysfunction, cervical malalignment, and restricted cervical mobility. In patients with concomitant cervical spinal cord injury or myelopathy, impaired respiratory mechanics and bulbar dysfunction may further increase airway vulnerability. Recent evidence suggests that postoperative airway vulnerability is dynamic rather than confined to the immediate perioperative period, with clinically significant respiratory and swallowing complications occurring days to weeks after surgery, including some after hospital discharge. This focused review summarizes contemporary evidence regarding perioperative risk stratification, pathophysiology, extubation planning, postoperative surveillance, and preventive strategies for airway complications after cervical spine surgery. Potentially modifiable perioperative interventions, including goal-directed fluid therapy, corticosteroid administration, endotracheal tube cuff-pressure management, and selective delayed extubation in selected high-risk patients, are discussed. Although current evidence supports protocolized multidisciplinary airway management pathways, important gaps remain regarding individualized prediction of postoperative airway compromise, optimal extubation criteria, and postoperative monitoring strategy.