- •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.
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.
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Published online: January 28, 2019
Accepted: December 23, 2018
Received: November 26, 2018
© 2018 Published by Elsevier Ltd.