Upper-Airway Obstruction After Short Posterior Occipitocervical Fusion in a Flexed Position

In Brief Study Design. Case report. Objective. 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. Summary of Background Data. 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. Methods. 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. Results. After revision surgery, the upper-airway obstruction disappeared. Conclusion. 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. This is a case report of upper-airway obstruction after posterior O–C2 fusion in a patient with rheumatoid arthritis. The major cause of the airway obstruction was considered to be a fusion in a flexed position, and the obstruction disappeared after correction of the O–C2 angle to the neutral position.