Chronic intermittent tachycardia as a consequence of vagus nerve injury after anterior cervical discectomy and fusion: case report of a previously unreported complication

Erik Werheim; Zachary Sokol; Neha Mody; Justice Owusu-Agyei

doi:10.1016/j.xnsj.2023.100291

Chronic intermittent tachycardia as a consequence of vagus nerve injury after anterior cervical discectomy and fusion: case report of a previously unreported complication

N Am Spine Soc J. 2023 Nov 4:16:100291. doi: 10.1016/j.xnsj.2023.100291. eCollection 2023 Dec.

Authors

Erik Werheim^{1

2}, Zachary Sokol^{1

2}, Neha Mody¹, Justice Owusu-Agyei¹

Affiliations

¹ Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015, United States.
² Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA 19140, United States.

Abstract

Background: The surgical approach of an anterior cervical discectomy and fusion (ACDF) navigates many important neurologic and vascular structures in the neck. More frequently reported complications are dysphagia, postoperative hematoma, cerebrospinal fluid leaks, and dysphonia.

Case description: This case report details an ACDF in a 49-year-old female with intractable neck pain and radicular symptoms. Following the procedure, she developed intermittent tachycardia at rest, which worsened with exertion.

Outcome: The cardiac workup was negative. A neck ultrasound demonstrated hypoechoic thickening of the vagus nerve, providing the diagnosis of vagus nerve injury. The patient's tachycardia has been managed with beta-blockers.

Conclusions: Although previously unreported, vagus nerve injury following ACDF is possible, causing sympathetic disruption, which can be managed with beta blockers.

Keywords: ACDF; Anterior cervical discectomy and fusion; Cervical; Complications; Tachycardia; Vagus nerve.

Publication types

Case Reports