Airway Compression as a Result of Extensive Prevertebral Hematoma Following Extension Injury of Lower Cervical Spine without Fracture/Dislocation

Kyung-Jin Song; Kwang-Bok Lee; Hyuk Park

doi:10.4055/jkoa.2012.47.3.227

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Song, Lee, and Park: Airway Compression as a Result of Extensive Prevertebral Hematoma Following Extension Injury of Lower Cervical Spine without Fracture/Dislocation

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(3): 227-231.

Published online: 26 June 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.3.227

Airway Compression as a Result of Extensive Prevertebral Hematoma Following Extension Injury of Lower Cervical Spine without Fracture/Dislocation

Kyung-Jin Song, M.D., Kwang-Bok Lee, M.D., Hyuk Park, M.D.

Department of Orthopedic Surgery, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea.

Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

Correspondence to: Kwang-Bok Lee, M.D. Department of Orthopedic Surgery, Chonbuk University Hospital, Chonbuk National University Medical School, 20, Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-2586, FAX: +82-63-271-6538, osdr2815@naver.com

Received 5 August 2011 Revised 18 October 2011 Accepted 27 December 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 77-year-old man presented with severe dyspnea, neck pain, tingling sensation in both hands, and weakness after an acute prevertebral soft tissue hematoma due to distractive-extension injury. Magnetic resonance images demonstrated an extensive hematoma accumulation, anterior longitudinal ligament and longus colli muscle injuries. We report here a case of dyspnea due to an extensive prevertebral hematoma by soft tissue injury without cervical vertebral fracture and/or dislocation and a review the relevant literature.

Keywords: dyspnea, prevertebral hematoma, distractive-extension injury

Figures and Tables

Figure 1

(A) Initial C-spine lateral radiograph shows extensive prevertebral soft tissue shadow (retropharyngeal space at C3: 29.3 mm, retrotracheal space at C6: 53.9 mm) without fracture/dislocation from C1 to thoracic area. The retropharyngeal space lies between the pharynx the pharynx and the cervical spine. (B) Post-trauma 1 week C-spine lateral radiograph shows the decrease of prevertebral soft tissue shadow compare to initial C-spine lateral radiograph. (C) Immediate post-operative C-spine lateral radiograph showed marked decrease of prevertebral soft tissue shadow and anterior cervical discectomy and fusion with plate and cage construct at C5-7.

Figure 2

Sagittal (A) and axial (B) computed tomography images show the compression and deviation of trachea (asterix) by extensive prevertebral soft tissue shadow (arrows) and no bony abnormality.

Figure 3

Sagittal (A, C) and axial (B, D) T1, T2-weighted magnetic resonance images show the deviation and compression of trachea (asterix) and esophagus (arrow head) by extensive hematoma in the prevertebral space (arrows) from C1 to T4, the tear of anterior longitudinal ligament and longus coli muscle, disc herniation C5-6, C6-7.

Figure 4

Operative photo shows the extensive hematoma and longus coli muscle tear (white arrows).

References

1. Emery SE, Smith MD, Bohlman HH. Upper-airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg Am. 1991. 73:544–551.

2. Howcroft AJ, Jenkins DH. Potentially fatal asphyxia following a minor injury of the cervical spine. J Bone Joint Surg Br. 1977. 59:93–94.

3. Kuhn JE, Graziano GP. Airway compromise as a result of retropharyngeal hematoma following cervical spine injury. J Spinal Disord. 1991. 4:264–269.

4. O'Donnell JJ, Birkinshaw R, Harte B. Mechanical airway obstruction secondary to retropharyngeal haematoma. Eur J Emerg Med. 1997. 4:166–168.

5. Silberstein M, Tress BM, Hennessy O. Prevertebral swelling in cervical spine injury: identification of ligament injury with magnetic resonance imaging. Clin Radiol. 1992. 46:318–323.

6. Fauci AS, Longo DL. Fauci AS, Braunwald E, Kasper DL, editors. Critical care medicine. Harrison's principles of internal medicine. 2008. 17th Edition. New York: The McGraw-Hill Companies;1681–1685.

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