A recent study from Seoul National University Bundang Hospital has provided important insights for surgical recovery following anterior cervical discectomy and fusion (ACDF). The research found significant variations in airway patency based on the postoperative neck and mouth positioning of patients, highlighting the effectiveness of neck extension with closed mouth as the optimal posture for maintaining airway clearance.
Airway obstruction is one of the most severe complications associated with ACDF, sometimes resulting from swelling of the prevertebral soft tissues (PSTS) post-surgery. Such complications can lead to dire outcomes, including respiratory failure or prolonged recovery times. Despite the prevalence of ACDF surgeries for conditions like cervical spondylotic myelopathy or radiculopathy, guidelines on postoperative positioning to prevent airway compromise have been scant.
The study aimed to explore how varying neck and mouth positions might influence airway characteristics. Researchers conducted a retrospective analysis of 39 patients who underwent ACDF due to cervical problems at the C3 and C4 levels. Using lateral radiographs taken within three days post-surgery, the authors assessed six different neck-mouth posture combinations: flexion-closed, flexion-open, neutral-closed, neutral-open, extension-closed, and extension-open.
The results demonstrated significant differences among these postures. Notably, the neck extension with closed mouth position led to greater airway diameters and less PSTS compared to other positions. "Neck extension with closed mouth significantly widened the airway diameter and reduced prevertebral soft tissue swelling, making it the best posture to maintain airway patency after ACDF," noted the study authors. This conclusion is particularly relevant as changeable states like postoperative swelling can threaten air passage, thereby delaying recovery.
While previous studies have focused on the extent of PSTS following cervical surgeries, this analysis is distinctive as it correlates these outcomes directly with definitive neck and mouth positions. The upper airway, particularly at the C2, C3, and C4 vertebrae levels, was primarily observed to show narrow diameters following the varying postures. This finding emphasizes the anatomical differences between the upper and lower airways, which may influence the susceptibility to obstruction.
The research underlines the anterior soft tissue structure's role, particularly the tongue, which can shift during changes to neck posture. The study finds, "Changes in the airway diameter are likely due to the anterior soft tissues, such as the tongue," indicating the soft tissue dynamics at play during patient positioning.
Given the potential for respiratory complications stemming from inadequate airway management post-surgery, these findings advocate for careful consideration of patient positioning. It brings to light the necessity for clinicians to adopt strategies involving neck extension with closed mouth when managing postoperative procedures, especially for patients at higher risk of airway obstruction.
The results are significant not just for surgical outcomes but also for the broader field of postoperative care, opening avenues for enhanced airway management protocols and patient recovery practices after anterior cervical surgeries. By establishing neck extension with the closed mouth as the preferred positioning, medical practitioners can potentially mitigate the postoperative risks associated with airway compromise.
While the study invites future research to corroborate these findings across different patient demographics and surgical techniques, it serves as a solid foundation for developing best practices aimed at safeguarding respiratory health following ACDF procedures.
