Unilateral diaphragmatic paralysis following cervical spine surgery in a patient with neurological symptoms: a case report and review of the literature

Rationale: Unilateral diaphragmatic paralysis is an extremely rare postoperative complication following cervical spine surgery. We present a case of unilateral diaphragmatic paralysis following cervical spine surgery in a patient with preoperative neurological symptoms and discuss the related literature. Patient concerns: A 74-year-old male presented with gait instability and frequent falls. Postoperatively, the patient developed dyspnea. Diagnoses: Postoperative imaging revealed right-sided diaphragmatic elevation, indicating phrenic nerve dysfunction. Cervical myelopathy at C3/4 and C4/5 levels was identified as a relevant underlying condition during the determination of the postoperative course. Interventions: The patient underwent anterior cervical discectomy and fusion (ACDF) at C3/4 and C4/5. Conservative management, including oxygen therapy and neurotrophic support, was provided postoperatively. Outcomes: Significant improvement in respiratory symptoms was observed by postoperative Day 42, with a reduction in right hemidiaphragm elevation on chest computed tomography (CT). The patient's dyspnea gradually improved with treatment, and respiratory function stabilized. Lessons: This case highlights the need to monitor for respiratory complications after cervical spine surgery, even in patients without preoperative respiratory symptoms. Neurological signs should prompt early recognition of phrenic nerve involvement to prevent further complications and improve outcomes.