Extruded Screw From Cervical Spine Hardware Causing Vocal Fold Paralysis.

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.