Phrenic Nerve Palsy After Posterior Cervical Fusion: A Case Report and Review of Literature.

Introduction: Cervical nerve palsies, most commonly C5, are relatively common following posterior cervical decompression and fusion (PCDF) for the management of cervical myelopathy. However, phrenic nerve palsy following PCDF is a rare complication documented in only one previous case report. The authors present a case of phrenic nerve palsy following PCDF.

Methods and material: The patient is a 51-year-old male who presented with cervical myelopathy and radiculopathy as well as cervicalgia of 1 year's duration. The patient underwent C3-C6 posterior cervical decompression and fusion (PCDF). On postoperative day 5, he was found to have a right C5 nerve palsy, which improved with steroid use and physical therapy. When he returned at 7 weeks postoperatively, the patient had progressive dyspnea. A fluoroscopic exam by pulmonology revealed a right-sided phrenic nerve palsy was the cause of the dyspnea.

Results and discussion: Phrenic nerve palsy causing hemi-diaphragmatic paralysis is a rare complication of cervical spine surgery that requires a high degree of suspicion due to the nonspecific signs and symptoms. Our clinical case suggests that surgeons should bear in mind phrenic nerve palsy as a potential complication in patients with respiratory distress following cervical laminectomy.