Late Airway Compromise Secondary to Dural Tear and Cerebrospinal Fluid Leak

Abstract

Background: While dysphagia after anterior cervical spine surgery is common, a dural tear is a rare complication. Airway compromise resulting from cerebrospinal fluid collection is an even rarer complication that has only been described to occur in the first few days postoperatively. Case Report: A 55-year-old male presented with progressive dysphagia and respiratory compromise 3 weeks after anterior cervical discectomy and fusion surgery at C3-C6. Imaging demonstrated extensive fluid collection in the retropharyngeal space and lateral neck, resulting in displacement of the cricoid cartilage rightward and anteriorly while also narrowing the pharyngeal space. After the patient's airway was secured by awake fiberoptic intubation, the fluid was determined to be cerebrospinal fluid (CSF) from a cervical dural tear. The tear was identified and repaired. The patient was extubated the next day, and a lumbar drain was placed to reduce the strain on the repair. After 11 days in the hospital, the patient made a full recovery. Conclusion: Dural tears following cervical disc surgery are rare and almost always identified in the immediate postoperative period; however, a dural tear should still be considered when a patient presents with a fluid collection at a later date. While techniques for securing the airway would not be different based on the type of fluid, knowing that the fluid collection is CSF could prompt the anesthesia team to place a lumbar drain.

Keywords: Airway management; airway obstruction; cerebrospinal fluid leak; cervical vertebrae; neck.