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

Case report


Bachar Hachwa, Mona Halim-Armanios.

Department of Anesthesiology, the Ohio State University Medical Center, Columbus, Ohio, USA

Libyan J Med, AOP: 061106 (published 18 November 2006)


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 post-extubation 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.