2021 Volume 12 Issue 9 Pages 1102-1109
Introduction: This study aimed to investigate prevertebral soft tissue swelling (PSTS) after anterior cervical spine surgery over time and to compare the PSTS before and after extubation. This study also aimed to clarify whether the PSTS before extubation can be an index for predicting airway stenosis after extubation.
Methods: In total, 28 patients (17 men and 11 women, mean age = 63 years) who underwent anterior cervical spine surgery and adapted our hospital's perioperative management protocol were included. The PSTS was measured at each level from C2 to C5 using cervical lateral radiographs. Radiological measurements were examined preoperatively, before extubation of POD1 (Pre-ex), after extubation of POD1 (Post-ex), 2 days after surgery (POD2), and 6 days after surgery (POD6). The rate of increase (ΔPSTS [%]) was measured at each postoperative period and at each level. Moreover, in POD2, bronchoscopy was performed. We examined (1) changes in ΔPSTS over time at each level, (2) correlation between pre-ex and post-ex, POD2, and POD6, and (3) comparison between ΔPSTS and bronchoscopic findings at POD2.
Results: The temporal changes in ΔPSTS at each level (Pre-ex, Post-ex, POD2, POD6) were C2 (212±112,190±82,301±132,198±101[%]), C3 (154±76,188±81,289±137,216±79[%]), C4 (152±62,178±66,250±108,224±87[%]), C5 (127±33,150±42,163±51,140±118[%]). The ΔPSTS was higher at the upper cervical, and the ΔPSTS was highest at POD2 in each level. The respective correlation coefficient between pre-ex ΔPSTS and ΔPSTS (post-ex, POD2, and POD6) at each timing after extubation were C2 level (0.53, 0.43, and 0.17), C3 level (0.61, 0.45, and 0.47), C4 (0.58, 0.57, and 0.58), C5 (0.81, 0.71, and 0.76). Moderate correlations were observed up to the POD2 at each level, whereas especially strong correlations were noted up to POD6 at the mid-cervical spine. Mean ΔPSTS on POD2 showed no statistically significant differences between patients with bronchoscopic abnormal findings and those without. There were no cases of airway obstruction or reintubation caused by postoperative complications.
Conclusions: The study outcomes showed that the PSTS before extubation is useful for predicting the deterioration of PSTS after extubation, and the evaluation of PSTS before extubation may help predict the occurrence of postoperative airway stenosis caused by PSTS.
