Horner’s Syndrome after single or two anterior cervical discectomy and fusion; clinical series

Abstract

BACKGROUND: Horner's syndrome (HS) is a rare postoperative complication after anterior cervical discectomy and fusion (ACDF). OBJECTIVE:This study aims to assess the incidence, patient's demography and surgical approach, outcomes and possible predictive factors for the occurrence of Horner's syndrome following the anterior approach for cervical discectomy. METHODS:A retrospective study of 820 patients who had single or successive two levels ACDF for cervical degenerative disc disease using PolyEtherEtherKetone (PEEK) cages between 2016 and 2019 was conducted. Charts were reviewed to identify patients with postoperative occurrence of Horner's syndrome with a follow up period of 12 months. Outcome for ptosis, being the most important factor, was classified according to margin to reflex distance. RESULTS:Forty patients had postoperative HS following ACDF out of 820 patients (4.8%). Around 67% of the patients with HS had single level discectomy, and the most frequent level was C5-6. The average age of patients with HS was 47 years, 55% were males, 33% were smokers and 20% were diabetics. Radiculopathy was more frequent than myelopathy. When anterior plate fixation system was used the incidence of Horner's syndrome was higher (60%). Improvement or complete resolution occurred in 90% of the cases.CONCLUSION: Using anterior plating system during ACDF increases the risk of Horner's syndrome. In most of the cases, Horner's syndrome is a temporary clinical manifestation that is managed conservatively. Rarely, surgical repair for ptosis might be required.

Horner Syndrome After Anterior Cervical Spine Surgery for Traumatic Spinal Cord Injury – A Rare Complication

“…An injury to the CST may be due to forceful retraction of the longus colli muscle at C5-C6, transversely cutting of the longus colli muscle, or dissection of the prevertebral fascia [ 4 ]. It can be avoided by limiting the use of electrocautery along the lateral border of the vertebral body and through the longus colli, sub-periosteal dissection, and fixing the retractors beneath the edge of the longus colli muscle, also by avoiding forceful and prolonged retraction, during surgery [ 13 , 14 ].…”

“…If it was due to retraction, improvement and complete recovery are possible. But, complete sectioning of CST results in the persistence of symptoms [ 13 , 2 ]. In our case, HS persists even after one year of surgery.…”