Life-Threatening Late Hemorrhage due to Superior Thyroid Artery Dissection After Anterior Cervical Discectomy and Fusion

Abstract

Study Design. Case report. Objective. The object of this report is to identify causes of late bleeding after anterior cervical discectomy and to suggest an optimal management plan. Summary of Background Data. The anterior discectomy and fusion is one of the most common spine procedures for cervical disc disease. Although this procedure has a low postoperative morbidity rate, rarely fatal vascular complications occur, the majority of which can be predicted intraoperatively. However, causes of unpredicted delayed bleeding are not fully understood. Methods. We reviewed the hospital charts and radiographs of a patient who underwent coil embolization for late bleeding after anterior cervical discectomy with fusion (ACDF). Results. A 33-year-old man underwent ACDF for cervical discs at C3-C4 and C4-C5. Intraoperatively, there was no major bleeding and the operation was completed after meticulous hemostasis. The patient was discharged 6 days after surgery without complications. However, at 16 days after surgery, the patient revisited the emergency room with sudden progressive neck swelling and accompanying respiratory difficulty. Because the neck swelling was rapidly progressing, the wound was opened in the intensive care unit under local anesthesia due to suspicion of hematoma. After evacuating the hematoma, we encountered active bleeding, which was controlled with gauze packing, but we were unable to identify the bleeding focus. After intubation, emergency right common carotid angiography was performed. Dissection of the right superior thyroid artery with active bleeding was identified, and this was promptly embolized with coils. After angiographic intervention, the remnant hematoma was removed in an operating room. The patient was discharged 5 days later without complication. Conclusion. This is the first report that shows late hemorrhage due to superior thyroid artery dissection after ACDF. This case cautions that intraoperative injury to an artery, unrecognized at operation, may cause late hemorrhage.