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This comprehensive review focuses on nerve injuries related to anterior approaches, including recurrent and superior laryngeal nerve palsy, C5 nerve root palsy, and hypoglossal nerve injury, and also covers less common events such as Parsonage-Turner syndrome, C8–T1 radiculopathy, and Horner’s syndrome. PubMed-indexed literature from the past 25 years is synthesized to describe anatomy, incidence, diagnosis, clinical features, and prevention/management strategies.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/nerve-injuries-in-cervical-spine-surgery-via-anterior-approach-a-comprehensive-review/450938/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/nerve-injuries-in-cervical-spine-surgery-via-anterior-approach-a-comprehensive-review/450938.png","ImageObject",300,407,{"name":92,"@type":93},"Bintang","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why are nerve injuries a significant concern in anterior cervical spine surgery?","Question",{"text":113,"@type":114},"The close anatomical relationship between the cervical spine and critical neural structures makes patients vulnerable to iatrogenic nerve damage, even though many injuries are temporary.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which nerve injuries does the review specifically address for anterior cervical approaches?",{"text":118,"@type":114},"It focuses on recurrent and superior laryngeal nerve palsy, C5 nerve root palsy, and hypoglossal nerve injury, and also discusses less common complications such as Parsonage-Turner syndrome, C8–T1 radiculopathy, and Horner’s syndrome.",{"name":120,"@type":111,"acceptedAnswer":121},"How were studies selected for this review and what time window was used?",{"text":122,"@type":114},"An advanced search of PubMed-indexed literature was performed using multiple search terms, aiming to include evidence from the past 25 years.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},450938,1790763139,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Nerve injuries in cervical spine surgery via anterior approach: a comprehensive review  \nSazid Hasan 1, Neal Farmer1, Isaac Arefi 1, Mackenzie Hagood 1, Pranav Gadangi 1, Haytham Alqasmi2, Muhammad Waheed2, Abdul-Lateef Shafau2, Yasser Abusabha1, Ehab Saleh3, Jad Khalil3, Hossein Elgafy1  \n1Department of Orthopaedic Surgery, University of Toledo, Toledo, OH, USA; 2Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA; 3Department of Orthopaedic Surgery, Beaumont Hospital Royal Oak, Royal Oak, MI, USA  \nContributions: (I) Conception and design: S Hasan, P Gadangi; (II) Administrative support: E Saleh, J Khalil, H Elgafy; (III) Provision of study materials or patients: E Saleh, J Khalil, H Elgafy; (IV) Collection and assembly of data: N Farmer, I Arefi, M Hagood, P Gadangi, H Alqasmi, M Waheed, AL Shafau, Y Abusabha; (V) Data analysis and interpretation: N Farmer, I Arefi, M Hagood, P Gadangi, H Alqasmi, M Waheed, AL Shafau, Y Abusabha; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Sazid Hasan, MD. Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Ave, Toledo, OH 43614, USA.  \nEmail: [sazhasan01@gmail.com](sazhasan01@gmail.com).  \nAbstract: Anterior cervical spine surgery is widely performed to manage degenerative, traumatic, and compressive spinal conditions. Despite its effectiveness, iatrogenic nerve injuries remain a significant concern due to the complex anatomy of the cervical region. This review offers a focused narrative on nerve injuries associated with anterior cervical approaches, including recurrent and superior laryngeal nerve palsy, C5 nerve root palsy, and hypoglossal nerve injury. Less common complications such as Parsonage-Turner syndrome (PTS), C8–T1 radiculopathy, and Horner’s syndrome are also addressed. Each injury is discussed in terms of anatomical relevance, incidence, clinical features, diagnosis, and strategies for prevention and management. A structured review of PubMed-indexed literature from the past 25 years was conducted to ensure the inclusion of current evidence. Risk factors such as multilevel surgery, revision procedures, and excessive retraction are highlighted. While many nerve injuries are self-limited, a subset may result in longterm deficits, reinforcing the need for meticulous surgical planning and intraoperative care. By increasing awareness of these complications, this review aims to inform surgical technique and reduce morbidity in anterior cervical spine surgery. This review emphasizes not only the incidence and anatomical relevance of these complications, but also underscores the importance of preventive measures such as careful retraction, intraoperative neuromonitoring, and preoperative planning. By synthesizing data across multiple studies and including rare complications such as Horner’s syndrome and PTS, this review provides a practical reference for surgeons aiming to reduce morbidity. Ultimately, the goal is to improve surgical safety and patient quality  \nof life through heightened awareness and refinement of technique.  \nKeywords: Postoperative complications; anterior approach; nerve injuries; injury prevention  \nSubmitted Mar 29, 2025. Accepted for publication Aug 15, 2025. Published online Dec 22, 2025.  \ndoi: 10.21037/jss-25-53  \nView this article at: [https://dx.doi.org/10.21037/jss-25-53](https://dx.doi.org/10.21037/jss-25-53)  \nIntroduction  \nCervical spine surgery is performed to address various pathologies, including degenerative disc disease, spinal stenosis, herniated discs, infection, tumor, and traumatic injuries. These procedures typically involve anterior, posterior, or combined approaches to decompress neural  \nstructures, stabilize vertebrae, or realign spinal deformities. Among the most common procedures for cervical spine surgery are anterior cervical discectomy and fusion (ACDF), cervical corpectomy, and posterior cervical decompression and fusion. Whi","cbCaidIOsgbF1mmi","https://ap.wps.com/l/cbCaidIOsgbF1mmi","pdf",565213,"English","# Introduction\n# Methods\n## Anatomy of the cervical spine\n# Nerve injuries associated with anterior cervical approaches\n## Recurrent laryngeal nerve palsy\n## Superior laryngeal nerve palsy\n## C5 nerve root palsy\n## Hypoglossal nerve injury\n## Less common complications (PTS, C8–T1 radiculopathy, Horner’s syndrome)\n# Prevention and management strategies","[{\"question\":\"Why are nerve injuries a significant concern in anterior cervical spine surgery?\",\"answer\":\"The close anatomical relationship between the cervical spine and critical neural structures makes patients vulnerable to iatrogenic nerve damage, even though many injuries are temporary.\"},{\"question\":\"Which nerve injuries does the review specifically address for anterior cervical approaches?\",\"answer\":\"It focuses on recurrent and superior laryngeal nerve palsy, C5 nerve root palsy, and hypoglossal nerve injury, and also discusses less common complications such as Parsonage-Turner syndrome, C8–T1 radiculopathy, and Horner’s syndrome.\"},{\"question\":\"How were studies selected for this review and what time window was used?\",\"answer\":\"An advanced search of PubMed-indexed literature was performed using multiple search terms, aiming to include evidence from the past 25 years.\"}]","Nerve Injuries in Cervical Spine Surgery via Anterior Approach - A Comprehensive Review | PDF",1790734107,23]