Contralateral Recurrent Laryngeal Nerve Palsy in Primary Anterior Cervical Corpectomy and Fusion: A Case Report

Recurrent laryngeal nerve palsy (RLNP) is a well-known complication of anterior cervical spine surgery, particularly in revision procedures, and can result in hoarseness, dysphagia, or complete vocal cord paralysis if severe. This complication typically presents on the side of the surgical approach. We present a case of a 76-year-old male with a rare contralateral RLNP following primary anterior cervical corpectomy and fusion (ACCF). This RLNP was undiagnosed before presentation at our clinic and was identified through preoperative otolaryngology consultation and flexible laryngoscopic examination. Therefore, we decided to perform a revision ACCF with hardware removal at C3-C6 using a left-sided approach to mitigate the risk of bilateral vocal cord paralysis. The case highlights the significance of preoperative laryngoscopy to diagnose and localize a potential RLNP before revision surgery, thereby reducing the risk of potentially life-threatening consequences of bilateral RLNP. These findings challenge the existing assumption that RLNP following primary ACCF occurs only on the side of the surgical approach, emphasizing the need for heightened vigilance in surgical planning and decision-making for revision anterior cervical spine procedures.