Postoperative Tapia syndrome after lumbar posterior lumbar interbody fusion: a case report

Tapia syndrome is a rare complication characterized by concomitant injury to the hypoglossal and vagus nerves, most commonly associated with airway procedures during general anesthesia. Its incidence is extremely low. Literature review reveals that most reported cases involve Tapia syndrome following posterior cervical spine surgery, with no documented cases of Tapia syndrome occurring after open posterior lumbar spine surgery. We report a case of a patient with intradural lumbar disc herniation who underwent routine lumbar PLIF (posterior lumbar interbody fusion) under general anesthesia. The surgery was uneventful with satisfactory clinical outcomes. However, postoperative hoarseness and tongue deviation were observed. Fiberoptic laryngoscopy revealed fixed abduction of the right vocal cord with normal mobility on the left side, suggesting right vocal cord paralysis and leading to a diagnosis of Tapia syndrome. Active management included neurotrophic agents, glucocorticoids, anti-edema medications, and a rehabilitation plan featuring articulation therapy. At the 2-year postoperative follow-up, hoarseness improved by 90%. Although Tapia syndrome following lumbar surgery is extremely rare, enhancing awareness and understanding of this condition is crucial. Particular attention should be given to patients presenting with hoarseness and deviated tongue protrusion after general anesthesia, ensuring timely detection, prompt diagnosis, and early intervention. This rare case (post-lumbar <5 reported) highlights prone positioning risks; vigilant monitoring and early SLP referral essential; conservative management effective in transient cases. This approach helps prevent misdiagnosis and missed diagnosis, thereby minimizing the adverse impact of complications on patients.