Horner’s syndrome due to postoperative hematoma following anterior cervical discectomy and fusion

Background: We report a symptomatic retropharyngeal hematoma resulting in a transient Horner’s syndrome in a 51-year-old female following an anterior cervical discectomy and fusion (ACDF). Case Description: A 51-year-old female underwent an ACDF at C5-6 for cervical spondylotic radiculopathy. On postoperative day 4, she developed a retropharyngeal hematoma and Horner’s syndrome. A review of the preoperative magnetic resonance imaging and intraoperative findings in this patient uniquely indicated that her middle sympathetic ganglion and nerve ran inside the common carotid artery. Conclusion: Here, we report a 51-year-old-female who, following an ACDF, developed a postoperative retropharyngeal hematoma that resulted in a Horner’s syndrome attributed to a neuroanatomic anomaly (i.e., middle sympathetic ganglion was of the “medial type”).