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Extruded Screw From Cervical Spine Hardware Causing Vocal Fold Paralysis.

Meriam Deeb1, Keith R Conti2, Jason F Ohlstein2

  • 1St. Luke's/Temple School of Medicine, Bethlehem, PA, USA.

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Summary

Delayed recurrent laryngeal nerve (RLN) injury can occur from migrating cervical spine hardware. A case report details a screw extrusion causing vocal fold paralysis, highlighting a previously undocumented cause of RLN damage.

Keywords:
computed tomographydysphagiadysphoniafacial nervelaryngologyotolaryngology

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Neurology

Background:

  • Recurrent laryngeal nerve (RLN) injury, causing dysphonia and dysphagia, is a known complication of head and neck surgeries.
  • Iatrogenic RLN injury typically results from traction or transection during procedures like thyroidectomy or anterior cervical spine surgery.
  • Delayed RLN injury due to cervical spine hardware extrusion has not been previously reported.

Purpose of the Study:

  • To report a unique case of delayed recurrent laryngeal nerve injury caused by extruded cervical spine hardware.
  • To document the clinical presentation, diagnostic findings, and management of this rare complication.

Main Methods:

  • Case presentation of a 63-year-old woman with hoarseness and dysphagia.
  • Diagnostic workup included strobovideolaryngoscopy and computed tomography (CT) scan.
  • Surgical intervention involved neck exploration, hardware removal, and vocal fold injection laryngoplasty.

Main Results:

  • The patient presented with right vocal fold immobility.
  • CT revealed a migrated C5-C6/C6-C7 anterior cervical discectomy and fusion (ACDF) screw compressing the right RLN.
  • Intraoperative findings confirmed the screw embedded within the RLN fibers.

Conclusions:

  • This case represents the first documented instance of cervical spine hardware extrusion causing delayed recurrent laryngeal nerve injury.
  • Migrating hardware should be considered in the differential diagnosis of delayed vocal fold paralysis after anterior cervical spine surgery.