Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis.

Abstract

Vagal nerve stimulation is a generally safe adjunctive treatment for medically refractory epilepsy. Nevertheless, reports of vocal cord dysfunction during stimulation can be found in the literature. When vagal nerve stimulation-induced vocal cord dysfunction is compounded with contralateral dysfunction, such as that which can occur after anterior cervical diskectomy and fusion, serious pulmonary complications can occur. A 56-year-old female presented to the emergency department 3 weeks postoperatively from a cervical 7-thoracic 2 anterior cervical diskectomy and fusion through a right-sided approach with new-onset, intermittent stridor. Otorhinolaryngology conducted a fiberoptic laryngoscopy and determined that the patient had a right vocal cord paralysis and intermittent left vocal cord paresis that coincided with activation of the patient's vagal nerve stimulator. The stimulator was shut off, and the patient's stridor disappeared. Vagal nerve stimulation-induced vocal cord paralysis is a rare but known complication. Given this potential for vocal cord dysfunction, neurosurgeons should plan further anterior cervical diskectomy and fusions accordingly to ensure that patients do not develop dysfunction of bilateral vocal cords. Should this develop, however, cessation of vagal nerve stimulation can improve or treat the pulmonologic complication that develops.