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Case Reports
. 2025 May;15(5):80-84.
doi: 10.13107/jocr.2025.v15.i05.5564.

Phrenic Nerve Palsy in Anterior Cervical Discectomy and Fusion: Rare as Hen's Teeth

Aditya Gupta  1 , Ira Dhawan  2 , Aakashdeep Singh  1 , Vishal Kumar  1 , Sarvdeep Singh Dhatt  1
Affiliations
Case Reports

Phrenic Nerve Palsy in Anterior Cervical Discectomy and Fusion: Rare as Hen's Teeth

Aditya Gupta et al. J Orthop Case Rep. 2025 May.

Abstract

Introduction: Phrenic nerve palsy is a rare but potentially serious complication. The clinical presentation can vary from being asymptomatic to severe respiratory distress requiring mechanical complication. In the Anglophone literature, there is only a single case report of bilateral phrenic nerve injury as a complication following anterior cervical discectomy and fusion (ACDF).

Case report: This case report describes a 52-year-old female who developed right-sided phrenic nerve palsy after undergoing ACDF for cervical spine trauma. The patient had respiratory distress immediately after surgery and Ultrasonography and X-rays revealed Rt phrenic nerve palsy. To the best of our knowledge, this is the first case of unilateral phrenic nerve palsy after ACDF at the C5-C6 level.

Conclusion: Unilateral phrenic nerve palsy probably occurred as a complication of ACDF for cervical spine trauma. Phrenic nerve palsy should be kept in mind as a serious complication of spinal surgery.

Keywords: Phrenic nerve palsy; anterior cervical discectomy and fusion; cervical spine trauma; post-operative complication; respiratory distress.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
AP and Lateral Radiographs of the cervical spine.
Figure 2
Figure 2
Sagittal CT scan showing grade 1 anterolisthesis of C5 over C6.
Figure 3
Figure 3
MRI showing cord contusion with upstream cord edema upto C2.
Figure 4
Figure 4
USG showing minimal movement with inspiration 5 days.
Figure 5
Figure 5
Chest X ray showing Right hemielevated diaphragm 1 week after surgery.
See this image and copyright information in PMC

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