Airway Obstruction Caused by Cerebrospinal Fluid Leakage After Anterior Cervical Spine Surgery
A Report of Two Cases
Han Soo Chang, MD; Shiro Kondo, MD; Junichi Mizuno, MD; Hiroshi Nakagawa, MD

Cerebrospinal fluid leakage is a relatively rare complication after an anterior cervical spine operation1, except when the diagnosis includes ossification of the posterior longitudinal ligament. In patients with such a diagnosis, the dura is usually thin because of long-standing compression by the ossification; furthermore, there may be a dural defect or dural ossification2. Although cerebrospinal fluid leakage may cause wound dehiscence and subsequent infection, it has not been recognized as a cause of airway problems, to our knowledge. In this report, we present two cases of postoperative cerebrospinal fluid leakage that caused acute airway obstruction, requiring emergency treatment.The patients were informed that data concerning the cases could be submitted for publication.

Case Reports

Case 1. A sixty-one-year-old man presented with mild sensory abnormalities of the upper extremities and a gait disturbance. Cervical spine radiographs, computed tomography scans, and magnetic resonance images showed segmental ossification of the posterior longitudinal ligament compressing the spinal cord at the C3-C4, C4-C5, and C5-C6 levels. The patient underwent anterior cervical decompression with inter-body fixation with cages. During this procedure, a dural tear with cerebrospinal fluid leakage occurred at the C5-C6 level and was repaired with a muscle patch and fibrin glue.

The evening of the next day, the patient showed signs of upper airway obstruction with rapidly progressive dyspnea. A cervical spine radiograph demonstrated enlargement of the prevertebral soft-tissue shadow (Fig. 1). Computed tomography of the cervical spine showed a large prevertebral mass with low density. After a failed attempt at fiberscopic intubation, we performed an emergency tracheostomy, and the patient underwent surgical exploration of the wound. When we opened the sutures in the platysma, cerebrospinal fluid flowed briskly out from the prevertebral space, decreasing the tension of the wound. We …

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