Document Type : Case Report

Authors

• Reza Nikandish ¹
• Alireza Zareizadeh ²
• Siavash Motazedian ³
• Sam Zeraatian ⁴
• Habib Zakeri ¹
• Fariborz Ghaffarpasand ⁵

¹ Department of Anesthesiology, Fasa University of Medical Sciences, Fasa, Iran.

² Department of Neurosurgery, Fasa University of Medical Sciences, Fasa, Iran.

³ Department of Otolaryngology, Fasa University of Medical Sciences, Fasa, Iran.

⁴ Department of Acute Care Surgery, Fasa University of Medical Sciences, Fasa, Iran.

⁵ Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusion (ACD/F). A 65-year-old man with cervical spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage.

Keywords

• Anterior cervical discectomy
• Anterior cervical fusion
• Cervical spine trauma
• Vocal cord paralysis