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Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis.
World Neurosurg. 2020 Feb; 134:76-78.WN

Abstract

BACKGROUND

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.

CASE DESCRIPTION

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Electronic address: david.e.horvat.mil@mail.mil.Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31678441

Citation

Horvat, David, et al. "Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis." World Neurosurgery, vol. 134, 2020, pp. 76-78.
Horvat D, Lovell J, Boulter J, et al. Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis. World Neurosurg. 2020;134:76-78.
Horvat, D., Lovell, J., Boulter, J., Sabersky, A., & Brown, J. (2020). Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis. World Neurosurgery, 134, 76-78. https://doi.org/10.1016/j.wneu.2019.10.132
Horvat D, et al. Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis. World Neurosurg. 2020;134:76-78. PubMed PMID: 31678441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis. AU - Horvat,David, AU - Lovell,John, AU - Boulter,Jason, AU - Sabersky,Abraham, AU - Brown,Joseph, Y1 - 2019/10/31/ PY - 2019/09/22/received PY - 2019/10/14/revised PY - 2019/10/21/accepted PY - 2019/11/5/pubmed PY - 2019/11/5/medline PY - 2019/11/4/entrez KW - Anterior cervical diskectomy and fusion KW - Complications KW - Stridor KW - Vagal nerve stimulator SP - 76 EP - 78 JF - World neurosurgery JO - World Neurosurg VL - 134 N2 - BACKGROUND: 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. CASE DESCRIPTION: 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. CONCLUSIONS: 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. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31678441/Case_of_Vagal_Nerve_Stimulator-Induced_Stridor_After_Anterior_Cervical_Diskectomy_and_Fusion-Induced_Vocal_Cord_Paralysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)32760-3 DB - PRIME DP - Unbound Medicine ER -