Nerve injuries in cervical spine surgery via anterior approach: a comprehensive review

Anterior cervical spine surgery is widely performed to manage degenerative, traumatic, and compressive spinal conditions. Despite its effectiveness, iatrogenic nerve injuries remain a significant concern due to the complex anatomy of the cervical region. This review offers a focused narrative on nerve injuries associated with anterior cervical approaches, including recurrent and superior laryngeal nerve palsy, C5 nerve root palsy, and hypoglossal nerve injury. Less common complications such as Parsonage-Turner syndrome (PTS), C8-T1 radiculopathy, and Horner's syndrome are also addressed. Each injury is discussed in terms of anatomical relevance, incidence, clinical features, diagnosis, and strategies for prevention and management. A structured review of PubMed-indexed literature from the past 25 years was conducted to ensure the inclusion of current evidence. Risk factors such as multilevel surgery, revision procedures, and excessive retraction are highlighted. While many nerve injuries are self-limited, a subset may result in long-term deficits, reinforcing the need for meticulous surgical planning and intraoperative care. By increasing awareness of these complications, this review aims to inform surgical technique and reduce morbidity in anterior cervical spine surgery. This review emphasizes not only the incidence and anatomical relevance of these complications, but also underscores the importance of preventive measures such as careful retraction, intraoperative neuromonitoring, and preoperative planning. By synthesizing data across multiple studies and including rare complications such as Horner's syndrome and PTS, this review provides a practical reference for surgeons aiming to reduce morbidity. Ultimately, the goal is to improve surgical safety and patient quality of life through heightened awareness and refinement of technique.