Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it?

We present a rare case of bilateral vocal cord injury (BVCI) following anterior cervical discectomy with fusion (ACD/F) in a 47 year old man. The patient experienced post-extubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy and made a full recovery. What is unique about this case is that the patient had no reason for a preexisting unilateral vocal cord injury (UVCI) prior to this surgery. There have been only two similar cases in the English literature in which the patients had a preexisting unilateral vocal cord paralysis (UVCI). We recommend a more detailed preoperative airway exam to include a voice exam with specific voice fatigue questioning on all patients coming for ACD/F. Such detailed assessment may uncover hidden UVCI and allow a safer perioperative period.