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We experienced a case who received a bone resection for ankylosing spinal hyperostosis through the anterior approach. He subsequently became asphyxic and suffered a cardiopulmonary arrest owing to a postoperative hematoma. His complaint before the surgery was sticking of his throat and dyspnea that continued for 3 years. X-ray films revealed an osteophyte on the anterior side of the C3-C6 vertebral bodies, and we made an anterior approach under general anesthesia. There were no problems during the surgery. After being returned to the ward without intubation, he complained that he had a catch in his throat that progressed little by little, and subsequently suffered a cardiopulmonary arrest at 5 hours after surgery. Upon revival, he had brain hypoxia. He passed away owing to malnutrition and pneumonia at 4 years after the surgery. To prevent this complication, it is important to have an understanding of this condition. We should have alerted the nurses that such a complication may occur after anterior spinal surgery. It is also important to be aware that intubation of such a case becomes difficult once the trachea has become compressed and curved because of a hematoma.

Background: Controversy remains regarding the subsequent degeneration of adjacent segments, and little reliable information could be found in the literature regarding long-term clinical results and adjacent segment degeneration. The objective of this study is to investigate the degenerative change of adjacent segments to the fusion site and clinical outcome after posterolateral lumbar fusion with pedicle screw instrumentation and identify the risk factors in degenerative change at adjacent segments., Methods: Thirty-two patients who underwent posterolateral lumbar fusion and were able to be followed over four years were evaluated in this study. The intervertebral disc height, percent of slip, lumbosacral joint angle, lumbar lordosis and disc angle were all examined. The postoperative progression of degeneration at adjacent segments were defined as more than a 50 % narrowing in the adjacent disc height or more than a 5 % slip in adjacent segments in comparison to the preoperative neutral lateral radiographs. The clinical results were assessed using an evaluation scores for lumbar lesions proposed by the Japanese Orthopedic Association., Results: Fifteen (46.8%) of the 32 patients had adjacent segment degeneration including slip or narrowing. No significant correlation was found between the adjacent segment degeneration and the recovery rate at the final follow-up. In addition, no significant correlation was observed between the adjacent segment degeneration at the lastest follow-up and postoperative radiographic measurements., Conclusions: The rate of radiographic degeneration at the adjacent segments was 46.8%. No significant correlation was found between degenerative change in the adjacent segments and the clinical results. We could not identify any preoperative radiographic factors which might have influenced the segments adjacent to the fusion.