Anterior cervical discectomy in a patient with huge thyroid tissue (goiter)

Enlarged thyroid gland (goiter) may hinder to reach anterior part of the vertebrae or may impose more retraction than usual. The patient had left arm pain, and his left biceps muscle strength was 3/5 and triceps muscle strength was 4/5. Physical examination of his neck showed no abnormality. We performed anterior cervical discectomy, but we did not reach to the anterior part of the vertebrae due to enlarged thyroid gland even making moderately forceful medial retraction. It is therefore, we performed thyroidectomy previously, and later we performed anterior cervical discectomy at the level of cervical 5-6 and cervical 6-7. It will be wise to excise the goiter and later continue to cervical discectomy rather than using forceful retraction in cases with no preoperative detection as in our case to prevent damage of the recurrent laryngeal nerve and hoarseness due to pressure effect of the medial retraction during the anterior cervical approach.