Tracheostomy after anterior cervical spine fixation

Terence O'Keeffe, Robert K. Goldman, John C. Mayberry, Christina G. Rehm, Robert A. Hart

Research output: Contribution to journalReview article

39 Citations (Scopus)

Abstract

Background: Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy. Methods: A retrospective review was undertaken of all adult trauma patients diagnosed with cervical spine fractures or cervical SCI admitted between June 1996 and June 2001 at our university Level I trauma center. Demographic data, severity of neurologic injury based on the classification of the American Spinal Injury Association (ASIA), complications, and use and type of tracheostomy were collected. In the subgroup of patients with unstable cervical spine injury that underwent anterior stabilization and tracheostomy, data regarding timing and technique of these procedures and wound outcomes were also collected. Categorical data were analyzed using χ2 analysis using Yates correction when appropriate, with p < 0.05 considered significant. Results: During this time period, 275 adult survivors were diagnosed with cervical spinal cord or bony injury. Forty-five percent of patients with SCI (27 of 60) and 14% of patients without SCI (30 of 215) underwent tracheostomy (p < 0.001). Moreover, on the basis of the ASIA classification system, 76% of ASIA A and B patients, 38% of ASIA C patients, 23% of ASIA D patients, and 14% of ASIA E patients were treated with tracheostomy (p < 0.001). In the subgroup that underwent both anterior spine fixation and tracheostomy (n = 17), the median time interval from spine fixation to airway placement was 7 days (interquartile range, 6-10 days), with 71% of these tracheostomies performed percutaneously. No patient developed a wound infection or nonunion as a consequence of tracheostomy placement, and there were no deaths because of complications of either procedure. Conclusion: These data support the safety of tracheostomy insertion 6 to 10 days after anterior cervical spine fixation, particularly in the presence of cervical SCI. The presence of severe motor neurologic deficits was strongly associated with the use of tracheostomy in patients with cervical spine injury. Percutaneous tracheostomy, which is our technique of choice, may be advantageous in this setting by virtue of creating only a small wound. The optimal timing and use of tracheostomy in patients with cervical spine injury requires further study.

Original languageEnglish (US)
Pages (from-to)855-860
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number4
DOIs
StatePublished - Oct 1 2004

Fingerprint

Tracheostomy
Spine
Spinal Injuries
Spinal Cord Injuries
Wounds and Injuries
Nervous System Trauma
Trauma Centers
Wound Infection
Neurologic Manifestations
Survivors

Keywords

  • American Spinal Injury Association (ASIA)
  • Anterior
  • Cervical spine
  • Fixation
  • Spinal cord injury
  • Tracheostomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Tracheostomy after anterior cervical spine fixation. / O'Keeffe, Terence; Goldman, Robert K.; Mayberry, John C.; Rehm, Christina G.; Hart, Robert A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 4, 01.10.2004, p. 855-860.

Research output: Contribution to journalReview article

O'Keeffe, Terence ; Goldman, Robert K. ; Mayberry, John C. ; Rehm, Christina G. ; Hart, Robert A. / Tracheostomy after anterior cervical spine fixation. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 57, No. 4. pp. 855-860.
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AU - O'Keeffe, Terence

AU - Goldman, Robert K.

AU - Mayberry, John C.

AU - Rehm, Christina G.

AU - Hart, Robert A.

PY - 2004/10/1

Y1 - 2004/10/1

N2 - Background: Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy. Methods: A retrospective review was undertaken of all adult trauma patients diagnosed with cervical spine fractures or cervical SCI admitted between June 1996 and June 2001 at our university Level I trauma center. Demographic data, severity of neurologic injury based on the classification of the American Spinal Injury Association (ASIA), complications, and use and type of tracheostomy were collected. In the subgroup of patients with unstable cervical spine injury that underwent anterior stabilization and tracheostomy, data regarding timing and technique of these procedures and wound outcomes were also collected. Categorical data were analyzed using χ2 analysis using Yates correction when appropriate, with p < 0.05 considered significant. Results: During this time period, 275 adult survivors were diagnosed with cervical spinal cord or bony injury. Forty-five percent of patients with SCI (27 of 60) and 14% of patients without SCI (30 of 215) underwent tracheostomy (p < 0.001). Moreover, on the basis of the ASIA classification system, 76% of ASIA A and B patients, 38% of ASIA C patients, 23% of ASIA D patients, and 14% of ASIA E patients were treated with tracheostomy (p < 0.001). In the subgroup that underwent both anterior spine fixation and tracheostomy (n = 17), the median time interval from spine fixation to airway placement was 7 days (interquartile range, 6-10 days), with 71% of these tracheostomies performed percutaneously. No patient developed a wound infection or nonunion as a consequence of tracheostomy placement, and there were no deaths because of complications of either procedure. Conclusion: These data support the safety of tracheostomy insertion 6 to 10 days after anterior cervical spine fixation, particularly in the presence of cervical SCI. The presence of severe motor neurologic deficits was strongly associated with the use of tracheostomy in patients with cervical spine injury. Percutaneous tracheostomy, which is our technique of choice, may be advantageous in this setting by virtue of creating only a small wound. The optimal timing and use of tracheostomy in patients with cervical spine injury requires further study.

AB - Background: Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy. Methods: A retrospective review was undertaken of all adult trauma patients diagnosed with cervical spine fractures or cervical SCI admitted between June 1996 and June 2001 at our university Level I trauma center. Demographic data, severity of neurologic injury based on the classification of the American Spinal Injury Association (ASIA), complications, and use and type of tracheostomy were collected. In the subgroup of patients with unstable cervical spine injury that underwent anterior stabilization and tracheostomy, data regarding timing and technique of these procedures and wound outcomes were also collected. Categorical data were analyzed using χ2 analysis using Yates correction when appropriate, with p < 0.05 considered significant. Results: During this time period, 275 adult survivors were diagnosed with cervical spinal cord or bony injury. Forty-five percent of patients with SCI (27 of 60) and 14% of patients without SCI (30 of 215) underwent tracheostomy (p < 0.001). Moreover, on the basis of the ASIA classification system, 76% of ASIA A and B patients, 38% of ASIA C patients, 23% of ASIA D patients, and 14% of ASIA E patients were treated with tracheostomy (p < 0.001). In the subgroup that underwent both anterior spine fixation and tracheostomy (n = 17), the median time interval from spine fixation to airway placement was 7 days (interquartile range, 6-10 days), with 71% of these tracheostomies performed percutaneously. No patient developed a wound infection or nonunion as a consequence of tracheostomy placement, and there were no deaths because of complications of either procedure. Conclusion: These data support the safety of tracheostomy insertion 6 to 10 days after anterior cervical spine fixation, particularly in the presence of cervical SCI. The presence of severe motor neurologic deficits was strongly associated with the use of tracheostomy in patients with cervical spine injury. Percutaneous tracheostomy, which is our technique of choice, may be advantageous in this setting by virtue of creating only a small wound. The optimal timing and use of tracheostomy in patients with cervical spine injury requires further study.

KW - American Spinal Injury Association (ASIA)

KW - Anterior

KW - Cervical spine

KW - Fixation

KW - Spinal cord injury

KW - Tracheostomy

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