Postoperative Conundrum: Horner Syndrome Secondary to Anterior Cervical Discectomy and Fusion Procedure

IntroductionHorner syndrome is a rare complication following anterior cervical discectomy and fusion (ACDF) surgeries, with an incidence rate of Case DescriptionWe report a case of a 45-year-old female with a history of non-Hodgkin's lymphoma and chronic obstructive pulmonary disease who developed Horner syndrome post-ACDF. Initially admitted for suspected cholecystitis found on imaging following a fall, the patient's clinical course was complicated by worsening cervical and lumbar pain. This prompted MRI evaluation revealing cervical stenosis at C5-C6 and ACDF was performed without intraoperative complications. However, on postoperative day three, the patient developed left eye ptosis and miosis, consistent with Horner syndrome. Subsequent MRI revealed a new fluid collection suggestive of a seroma. Despite conservative management, Horner syndrome persisted. Discussion Horner syndrome post-ACDF is a rare but potentially lifelong complication. Possible etiologies include prolonged retraction of the longus colli muscle and postoperative inflammation leading to seroma formation, potentially compressing sympathetic nerve fibers. Current literature suggests under diagnosis of Horner syndrome post-ACDF, emphasizing the need for heightened clinical suspicion. Future research should focus on refining surgical techniques to minimize sympathetic trunk damage and facilitate early diagnosis and management of this rare complication.