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Abstract Details

Acute Neurological Consultation in Patients with Cervical Orthopedic Intervention
Cerebrovascular Disease and Interventional Neurology
P14 - Poster Session 14 (11:45 AM-12:45 PM)
We review two case presentations of acute neurologic consultation in patients that underwent recent anterior cervical disc fusion (ACDF). Injury of the cervical sympathetic trunk can occur with surgical manipulation of the pre vertebral fascia and/or injury of the longus capitis muscle. Partial Horner syndrome has been noted as a potential complication in ACDF and should be high on differentials for neurologists consulting for cranial nerve deficits in patients with recent anterior cervical disc fusion.

Case 155 year old female underwent ACDF through the anterior approach and post operatively was found to have left eye ptosis and anisocoria for which an inpatient stroke code was activated. Exam showed prominent ptosis, 2 mm miosis, sluggishly reactive to light. Hidrosis was preserved and the remainder of the neurological exam was intact. Neuroimaging was unremarkable, including CT angiography which was negative for arterial dissection.

Case 270 year old male presented to our ED two weeks after undergoing ACDF, with complaints of dysphagia, left sided ptosis and anisocoria. Neurology was consulted to evaluate concern for new onset ocular myasthenia gravis. History disclosed that he noted the ptosis soon after his ACDF surgery. Exam demonstrated the left eyelid ptosis with anisocoria, and anhidrosis was reported. Prior documentation revealed complications with neck hematoma during the peri-operative period precipitating his symptoms of dysphagia.

We report two illustrative cases of partial Horner syndrome noted post operatively following anterior cervical disc fusion performed with anterolateral approach. This is a reported potential complication of ACDF and can occur due to interruption of the cervical sympathetic trunk, at risk of injury when the longus Capitus muscle is cut or during dissection of the pre vertebral fascia. Awareness of this rare neurologic manifestation of cervical disc fusion can assist in avoiding unnecessary testing for other neurologic disease.
Ashwini Gadalay, MBBS
Dr. Gadalay has received personal compensation for serving as an employee of State university of New york, upstate medical university.
Raja Hassan Imtiaz, MBBS Dr. Imtiaz has nothing to disclose.
Navreet Kaur, MBBS (Boston University Medical Center) Dr. Kaur has nothing to disclose.
Hesham Masoud, MD (Department of Neurology) Dr. Masoud has nothing to disclose.