Neck extension with closed mouth position provides optimal airway patency after anterior cervical spine surgery at C3-4 and C4-5: a single-center retrospective case series

Airway compromise due to prevertebral soft tissue swelling is a potentially devastating complication following anterior cervical discectomy and fusion (ACDF). However, there are no studies on the postoperative patient posture for enhancing airway patency after ACDF. This study aimed to analyze the effect of neck and mouth postures on airway patency following ACDF and to suggest the beneficial postoperative patient posture for improving airway patency. A retrospective review of 39 patients who underwent ACDF in C3 or C4 level was conducted. Airway diameter and prevertebral soft tissue thickness were measured in six different neck-mouth postures using lateral radiographs. The diameters of the airway and prevertebral soft tissues showed significant changes in relation to the neck postures and mouth openings after ACDF (P < 0.001). Regarding postures, neck extension with closed mouth posture showed significant wider airway diameter than that of the other postures (P < 0.001). Moreover, this posture showed the thinnest prevertebral soft tissues; however, it showed no significant difference compared to the neutral-closed and extension-open postures (P = 1.00 and P = 0.053). In conclusion, neck extension with a closed mouth significantly widened the airway diameter and reduced prevertebral soft tissue swelling, making it the best posture to maintain airway patency after ACDF.