28. Prevertebral soft tissue swelling after ACDF

Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S CONCLUSIONS: Our results demonstrated that rapid detection of spinal cord ischemia with intraoperative Micro-Vascular Doppler ultrasound could reduce incidence of both false-negative and delayed detection of spinal cord ischemia compare to electrophysiological monitoring. In addition, application of Micro-Vascular Doppler ultrasound could provide an adequate time-window for reversible spinal cord injury. The results indicated that Micro-Vascular Doppler ultrasound could be used as either independent or supplemental technique in addition to traditional electrophysiological monitoring. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.028

Wednesday, October 27, 2004 3:55–4:35 PM Concurrent Sessions 1A: Cervical Spine Surgery 3:55 28. Prevertebral soft tissue swelling after ACDF Kyung-Soo Suk1, Ki-Tack Kim2, Sung-Chul Bae2; 1Kyung Hee University, Seoul, South Korea; 2Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea BACKGROUND CONTEXT: Airway complication after anterior cervical surgery is a rare but potentially lethal complication. PURPOSE: To identify the natural course of prevertebral soft tissue swelling after one- or two-level anterior cervical discectomy and fusion (ACDF) and to help preventing potentially lethal airway complication after ACDF. STUDY DESIGN/SETTING: Prospective study of 87 ACDF patients. PATIENT SAMPLE: Eighty-seven patients who underwent one- or twolevel ACDF with plate and screws were studied. OUTCOME MEASURES: Prevertebral soft tissue was measured from C2 to C6 on cervical spine lateral radiography. METHODS: Cervical spine lateral radiography was taken preoperatively, on immediate postoperative day, 1st, 2nd, 3rd, 4th and 5th day after surgery. Prevertebral soft tissue was measured from C2 to C6 on cervical spine lateral radiography. RESULTS: The mean prevertebral soft tissue was measured as follows. Prevertebral soft tissue swelling occurred postoperatively and was increased markedly on the second day after surgery. Peak prevertebral soft tissue swelling was found on the second and third day after surgery. The prevertebral soft tissue swelling was gradually decreased from the fourth day after surgery. Prominent swelling of prevertebral soft tissue was found at the 2nd, 3rd and 4th cervical spine. There were no significant differences of prevertebral soft tissue swelling between one-level and two-level ACDF group. Only one patient required reintubation (1.1%).

C2 C3 C4 C5 C6

Preop

Postop

Day 1

Day 2

Day 3

Day 4

Day 5

3.5 3.7 6.1 14.4 15.5

5.1 6.1 9.7 16.2 17.2

6.9 8.9 12.0 17.2 17.8

10.2 12.7 14.5 17.6 17.3

9.7 12.9 14.7 18.0 18.0

7.2 10.4 13.0 16.6 18.0

5.9 9.0 12.0 16.8 18.0

17S

4:02 29. Cervical prevertebral soft tissue standards: a longitudinal radiographic study in a normal pediatric population Jeffrey Roh, MD, Jung Yoo, MD, Daniel Cooperman, MD; Case Western Reserve University, Cleveland, OH, USA BACKGROUND CONTEXT: Evaluation and management of cervical spine injuries is frequently difficult in pediatric populations. Prompt and accurate diagnosis of cervical spine trauma can be impeded by the absence of obvious radiographic evidence of injury. Measurement of prevertebral soft tissue (PVS) swelling is a commonly used radiographic parameter to detect the presence of cervical spine injury. PURPOSE: To document the PVS measurements in normal individuals followed longitudinally from infancy to adulthood in order to establish normal standards in pediatric populations. STUDY DESIGN/SETTING: A longitudinal radiographic assessment of cervical spine PVS measurements taken in a prospective manner. PATIENT SAMPLE: Thirty-two normal healthy subjects (16 male and 16 female) followed from 3 months of age to skeletal maturity. OUTCOME MEASURES: Normal PVS measurements taken from subjects at all observed cervical spine levels. METHODS: Annual cervical spine radiographs from 3 months to 19 years of age were evaluated from the Bolton-Brush Growth Study collection (Cleveland, OH). At C1, PVS measurements were made from the anterior ring to the posterior airway shadow parallel to the C1 axis. Measurements at C2-6 were made parallel to the cervical endplates from the anteroinferior vertebral margin to the posterior margin of the airway shadow. The Laryngoesophageal Junction (LEJ), defined as the radiolucent junction of the larynx and esophagus, was identified and used as a radiographic marker to study the normal growth and caudal descent of the laryngeal airway and its effect on cervical PVS measurements. RESULTS: A total of 1716 cervical levels were measured from 332 lateral cervical radiographs at all observed levels. The mean PVS measurements (and SD) for all subjects at each cervical level were as follows: At C1, 6.1mm (2.7); at C2, 3.4mm (1.2); at C3, 3.9mm (1.8); at C4, 5.5mm (2.5); at C5, 8.4mm (2.1); at C6, 8.8mm (2.3). From three months of age to skeletal maturity, the PVS measurement at the C2-4 levels decreased over

Fig. 1. CONCLUSIONS: Peak prevertebral soft tissue swelling was found on the second and third day after surgery. Therefore, maintaining intubation in high-risk patients should be kept for 3 or 4 days after surgery. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No Conflicts. doi: 10.1016/j.spinee.2004.05.029

Fig. 1. PVS—Prevertebral soft tissues (black arrows). LEJ—Laryngoesophageal Junction (arrowhead).