Post cervical spine surgery complications

[malgal]

51 yo female who experienced a workplace injury d/t a fall in June 2019. ACDF C5-C7 with C6 corpectomy, placement of cage, plate and screws in June 2020. Also diagnosed with OPLL and part of the ligament was removed. Around August 2021 began experiencing neuro symptoms similar to pre-op of numbness, tingling, weakness of BUE, left worse than right, neck pain, severe headaches. MRI showed plate had "migrated" and was caught under C4. Upon flexion, the hardware was impinging on the spine. Sx 4-20-2022, hardware removal, C4 discectomy, C4-5 fusion, new plate from C4-C7. No return of OPLL. Upon awakening in PACU, left arm paralysis, but able to bend wrist and wiggle fingers. Extreme difficulty swallowing. 5 mo post-op, finally able to move arm after extensive therapy. 7 mo post-op, still experiencing swallowing difficulties, complete collapse of pharyngeal tissue upon flexion of neck, partial collapse upon rotation to left. Voice dysfunction, inability to sing d/t "warbling" effect, hoarseness, partial sentences/words inaudible. Swallowing study shows narrowing d/t pharyngeal collapse, shunting of food to epiglottic vallecula, absence of complete epiglottal closure d/t narrowing, choking. Patient experiences difficulty breathing and swallowing when maintaining head in a neutral position. Finds it necessary to slightly tip chin in order to not feel starved for air. Speech pathologist found left sided tongue and submandibular weakness. Currently performing electrotherapy and home exercises. Patient experiences transient difficulty pronouncing words, difficulty retrieving the correct word and often replaces the word with a similar, but incorrect word. Patient has difficulty focusing and trying to figure out how to perform job at times. Also experiencing dizziness, frequent headaches, left leg weakness when fatigued, difficulty reading d/t vision issues (Vision test performed and glasses prescribed. Pt does have dry eye and is treating, but still unable to see clearly) Physical therapy indicated ps stroke d/t manifestation of left sided dominant weakness. MRI of brain showed no apparent area of infarct. Swallow study and laryngoscopy showed "significant bulge" where hardware was pressing on the left side of the esophagus according to the speech pathologist and ENT. Surgeon states hardware in correct placement and not touching esophagus. Patient had intraoperative monitoring during surgery. Would a small stroke have been visible on the monitoring system? Also, any idea where to go from here for treatment or narrowing down a diagnosis? Should patient see a neurologist or a different type of specialist? Neurosurgeon has been treating since surgery. Patient also sees PT, ST and pain management. She has seen ENT twice for the laryngoscopy. Any other suggestions as to what could be causing the pharyngeal collapse?

[GuitarRox]

Since you've had difficulty swallowing and speaking and left side of the body weakness, I'd consider if she'd had a stroke. Have symptoms gotten better? She could have nerve damage or inflammation can be the reason as well. A full evaluation with a neurologist sounds like the right thing to do. At that time, then it can be determined if an ENT would be helpful for eating/speaking issues. Physical therapy for the improvement of bodily function as well.