Title : Post-operative horner’s syndrome (HS): A case report on a rare complication after anterior cervical discectomy and fusion (ACDF) surgery
Abstract:
Introduction
The gold standard for correcting Cervical degenerative disc disease (CDDD) is Anterior Cervical Discectomy and Fusion (ACDF), a safe, effective procedure. Horner’s Syndrome (HS) is an extremely rare complication immediately post-ACDF due to impairment of the sympathetic trunk.
Case report
The patient, a 48-year-old woman, with CDDD-related pain and radiculopathy, was counselled and consented for C5/6 and C6/7 ACDF. ACDF was performed by standard anterior left-sided incision at appropriate levels. Contrasting with our usual practice, deeper-toothed retractors were employed for better exposure. Two cages were inserted at C5/6 and C6/7. Standard ACDF procedural time was taken at 180 minutes without intra-operative complications.
Discussion
The patient experienced significant relief of CDDD symptoms immediately post-ACDF, however, developed sudden onset left-sided HS, with ptosis, miosis and anhidrosis approximately 48-hours post-ACDF. By 2-weeks post- operative follow-up, she exhibited clinical improvement, and by 12-weeks, her HS had completely resolved, with no residual effects.
Conclusion
This case study is the first documented instance of delayed-onset HS post-ACDF to our knowledge. It may possibly be associated with the type of retractors used, resulting in neuropraxia or strain on the sympathetic chain ganglia. We recommend adequate exposure while minimizing excessive retraction of the longus colli muscle to reduce irritation to the sympathetic trunk.
What will audience learn from your presentation?
- The audience can learn the causes of potential post-operative complications of ACDF, including but not limited to Horner’s Syndrome, albeit rare, which is the focus of this paper.
- This paper raises awareness of the possibility of delayed-onset Horner’s Syndrome, the possible hypothesis for its pathophysiology, potential triggers, course and how it differs from immediate post-operative Horner’s syndrome and management
- Through this paper, we hope to delve deeper in the specific techniques of ACDF that can help reduce the potential complications and spark further interest and research in the area of delayed-onset Horner’s Syndrome to determine its cause, pathophysiology and management
