Horner Syndrome After Anterior Revision Surgery for Cervical Spondylotic Myelopathy: A Very Rare Complication

Abstract

Case: We report a case of postoperative left-sided Horner syndrome (blepharoptosis, miosis, and anhidrosis) after revision surgery for cervical spondylotic myelopathy. A C4 corpectomy and an anterior cervical fusion from C3 to C5 were performed through a left longitudinal approach in a patient with a surgical history of an anterior discectomy and a fusion from C5 to C6. One year after the revision surgery, the patient had recovered from the anhidrosis and the miosis, but the blepharoptosis was not fully resolved. Conclusion: Horner syndrome resulting from surgical injury to the ipsilateral cervical sympathetic chain is a very rare complication of anterior spine surgery that has been reported when the lower cervical levels have been approached. Awareness of this important cervical structure may help to avoid this complication.

Horner’s Syndrome and Vertebral Artery Occlusion Concomitant With Brachial Plexus Injury in a Patient With Anterior Approach Cervical Disc Herniation Surgery

“…In line with previous reports we observed a pseudo-meningocele cavity at the C5-6 level, reported being the most affected level through the cervical chain [5]. The anatomical proximity of the cervical sympathetic trunk to longus colli muscle makes it vulnerable to injury at the lower part (especially at the C5-6 level) of the cervical spine [6,9]. In our case, electroneuromyographic findings were compatible with brachial plexus upper trunk injury.…”

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

“…9,12,19 The reported resolution rate of HS after ACDF in the literature, ranges between 80%-100%. 1,9,13,14,18,[31][32][33][34] In the current study, HS occurred immediately postoperative, and through 1 year 10% of patients had complete recovery, 80% had partial recovery of the ptosis while 10% had no improvement. Margin to reflex distance was used to assess the blepharoptosis degree as it is the main cosmetic concern with the limitation of the upper field of vision.…”

“…[26][27][28][29][30] Such findings can explain why there was a higher incidence of HS when plate fixation system was used in our current study (60% of total cases), as more extensive exposure and traction was needed. 13,14 In our current series, right side HS (75%) was more common than left side. In 77% of the patients the right side approach was performed, while in 18% of the cases HS mismatched the side of the approach for ACDF.…”

“…Horner's syndrome is an uncommon complication after anterior cervical discectomy and fusion, but with more utilization of this approach, this complication is observed more frequent. 11,13,14 Horner's syndrome is caused by central, preganglionic and postganglionic causes. Preganglionic injury to the sympathetic fibers to the orbit and its adnexa might result from injury to sympathetic plexus that occurs during surgical approach to the cervical disc with dissections that expose the lateral edge of vertebral body, uncovertebral joint, and foramen transverserium.…”

“…[10][11][12] Horner's syndrome causes functional loss as well cosmetic impairments causing unsatisfactory outcome to patients. 13,14 This study aims to assess the incidence, patient's demography and surgical approach, outcomes and the predictive factors for occurrence of HS following ACDF.…”