Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it?

Abstract

We present a rare case of bilateral vocal cord injury (BVCI) following anterior cervical discectomy with fusion (ACD/F) in a 47 year old man. The patient experienced postextubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy and made a full recovery. What is unique about this case is that patient had no reason for a preexisting unilateral vocal cord injury (UVCI) prior to this surgery. There have been only two similar cases in the English literature in which the patients had a preexisting unilateral vocal cord paralysis (UVCI). We recommend a more detailed preoperative airway exam to include a voice exam with specific voice fatigue questioning on all patients coming for ACD/F. Such detailed assessment may uncover hidden UVCI and allow a safer perioperative period.

Keywords: Anterior cervical discectomy, Bilateral vocal cord injury, Vocal cord paralysis, Endotracheal intubation, Tracheostomy, Voice analysis, Hypoxia, Postoperative complications, and Post Anesthesia Care Unite Events

Libyan Journal of Medicine Vol. 1 (2) 2006: pp. 156-161