Abstract
Study Design Case report.
Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted
pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and
how this may overlap with the signs of Tapia syndrome; we also report our approach
to the clinical management of this patient.
Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after
posterior instrumentation and arthrodesis at the level of T1–L1. After extubation,
the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach
in the cortex of the anterior body of T1 corresponding to the RLN on the right.
Results Otolaryngological examination noted right vocal fold immobility, decreased sensation
of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated
right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during
a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy
tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated
reduced aspiration, and the patient reported complete resolution of symptoms. The
feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia
syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon
neuropraxia, which has previously not been observed in association with a breached
vertebral body at T1 along the course of the RLN.
Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms
persist postoperatively and spine surgeons should be aware of this as a potential
complication of guidewires in spinal instrumentation.
Keywords
pedicle screw - cortical breach - guidewire - tapia syndrome - neuropraxia
