Long term delay in onset of prevertebral hematoma following anterior cervical discectomy and fusion: A case report. (April 2019)

• Record Type: Journal Article
• Authors: McDowell, Michael M.; Parry, Phillip V.; Agarwal, Nitin; Miele, Vincent J.; Maroon, Joseph C.
• Is Part Of: Journal of clinical neuroscience. Volume 62(2019)
• Page Start: 234
• Page End: 237
• Publication Date: 2019-04
• Subjects: Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.12.031
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Post-operative cervical hematomas are a life threatening event. Hematomas mostly manifest within 3–7 days of surgery. Post-operative airway complaints should always arouse suspicion of hematoma formation. Hematomas with evidence of airway obstruction are a neurosurgical emergency. The airway should be secured quickly and the hematoma evacuated as soon as possible. Abstract: Post-operative hematoma following anterior cervical discectomy and fusion (ACDF) is an uncommon but feared complication. Typically, these complications present in the immediate post-operative period. We present a case of a 51 year-old woman who underwent a C4-5 ACDF for left sided radicular pain. Her immediate post-operative course was uncomplicated, but she presented 6 weeks subsequently to the emergency department with neck swelling, difficulty swallowing, cough, and shortness of breath. She was found to have a 4.5 cm anterior neck hematoma with settling of the instrumentation and a new C4 vertebral fragment protruding anteriorly. She underwent evacuation of hematoma without clear evidence of a bleeding source. After several days of observation, she was discharged home and ultimately had resolution of her presenting symptoms. Most hematomas resulting in airway compromise appear in the immediate post-operative period, but a high index of suspicion must remain high in any patient with a prior anterior cervical surgery presenting with symptoms of pre-vertebral compression or respiratory compromise.