Severe angioedema causing airway obstruction after anterior cervical surgery.

Abstract

A case of severe postoperative angioedema after excision of cervical osteophyte is presented. Emergent tracheostomy was required. To discuss the etiologies, diagnosis, and management of this unusual cause of acute respiratory distress after an anterior cervical spinous procedure. To our knowledge, angioedema as a complication of cervical spine surgery has not been reported previously. The patient had no history of angioedema, was not receiving an acetyl choline esterase inhibitor, and had a normal C1-esterase-inhibitor level. The patient was a 61-year-old man with ankylosing spondylitis who, because of progressive dysphagia and choking episodes, underwent excision of a large C3-C4 osteophyte and anterior cervical discectomy and fusion. While in the postanesthesia care unit, the patient experienced massive edema of the tongue and neck, with associated difficulty breathing. Reexploration of the wound revealed a small (30 cc) hematoma, which was removed with no obvious benefit to the patient, who ultimately required a tracheotomy. The patient was managed with intravenous corticosteroids. The tracheotomy tube was removed without incident after 7 days. The patient noted decreased neck pain and dramatic improvement in his ability to swallow postoperatively. He has had no further incidents of angioedema, to date. Angioedema should be considered in the differential diagnosis in patients with upper extremity respiratory obstruction after anterior surgery of the cervical spine.