Bilateral phrenic nerve palsy as a complication of anterior decompression and fusion for cervical ossification of the posterior longitudinal ligament.

Abstract

A case report of bilateral phrenic nerve palsy as a complication of anterior decompression and fusion for cervical ossification of the posterior longitudinal ligament (OPLL). To present a case of a rare and serious complication of cervical spinal surgery and to investigate its cause. There have been a number of reports of phrenic nerve palsy after cardiac surgery, but the authors have found no previous description of this complication related to spinal surgery. The authors describe the clinical presentation and management of a case of bilateral phrenic nerve palsy subsequent to the surgery for cervical OPLL. Also, the literature is reviewed concerning surgical approaches for the treatment of OPLL and the occurrence of phrenic nerve palsy subsequent to any form of therapy. Bilateral phrenic nerve palsy occurred after anterior decompression and fusion for cervical OPLL. Bilateral phrenic nerve palsy was diagnosed radiographically: postoperative chest radiograph showed bilateral laxity of the diaphragm. Movement of the bilateral diaphragm appeared 3 weeks after surgery. The patient successfully returned to normal daily life after ventilatory support for 3 months, although nocturnal oxygen support was still necessary at the latest follow-up, 3 years after surgery. The possible causes of this complication include bilateral C4 nerve root stretching, iatrogenic injury of the gray matter in the ventral horn, alteration of blood circulation related to spinal edema, or re-impingement on the spinal cord at the cranial part of the decompression site. Bilateral phrenic nerve palsy occurred after anterior decompression and fusion for cervical OPLL. Bilateral phrenic nerve palsy should be kept in mind as a serious complication of spinal surgery. It should be considered when patients unexpectedly fail to wean from the ventilator after surgery.