A Case of Acute Airway Obstruction Due to Retropharyngeal Hematoma Triggered by Delirium after Anterior Cervical Decompression and Fusion

Case presentation : A 49-year-old male with claustrophobia presented with numbness in his left upper extremity and weakness in both lower extremities following a fall. Proximal muscle weakness in the lower extremities, sensory insensitivity in both fingers, and the area up to T10 were also observed. Cervical spine computed tomography (CT) revealed osteophytes at the C5/6 level, while magnetic resonance imaging (MRI) confirmed a C5/6 disc herniation. The diagnosis was cervical spondylotic myelopathy with a herniated disc, leading to the decision of performing C5/6 stand-alone anterior cervical decompression and fusion (ACDF). Hemostasis was confirmed during the procedure. Immediately after extubation, the patient experienced discomfort, feeling hot and panic, and attempted to remove the neck collar by violently moving the neck. Approximately 3 h later, the patient experienced respiratory distress and went into cardiopulmonary arrest. Tracheal intubation was performed swiftly without opening the wound, and the patient regained consciousness. CT confirmed the presence of a hematoma extending from the retropharyngeal space to the front of the neck along with tracheal deviation. The patient was conservatively managed while intubated and sedated and was successfully extubated on the 6th day. The patient was discharged without any dysphagia or neurological deficits.