Postoperative hemorrhage after anterior cervical discectomy and fusion
Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain
Surgeons need to be alert for this complication and try their best to prevent it 1) 2) 3) 4), because it is one of the most catastrophic complications of anterior cervical discectomy and fusion(ACDF), which may result in dyspnea, respiratory arrest, and death 5) 6) 7) 8) 9) 10).
The reported incidence of this postoperative complication has varied from 0.2% to 1.9% 11).
Fountas et al. reported that postoperative hematoma occurred in 5.6% patients who underwent ACDF, 2.4% of whom required reoperation 12).
However, Aono et al.reported an incidence of 0.21% 13).
Neck swelling and progressive respiratory disturbance have become important, as proposed in the guidelines by Palumbo et al 17).
The results of the study of Kogure et al. indicated that indwelling drains are not necessary in patients who undergo one-level anterior cervical fixation surgery, and that observation of the prevertebral space (PVS) on simple cervical spine radiographs is the simplest and most useful method to determine any complications 18).
Basques et al. 19) measured the amount of drainage. Only a few reports have mentioned the drainage status, even in case reports of postoperative hematomas. Furthermore, one report documented the absence of drainage 20).
In the early postoperative period, when bleeding from the superior thyroid artery was excluded, the point of bleeding during the time of reoperation has been unclear in many cases 21).