Partial hyoid bone resection to reduce superior laryngeal nerve traction injury in upper cervical ACDF: technical description and retrospective case series of C3-4

Abstract

Purpose To describe a partial hyoid resection (PHR)-assisted anterior retropharyngeal approach for upper cervical Anterior Cervical Discectomy and Fusion (ACDF) and evaluate its feasibility and early outcomes compared to the conventional approach without hyoid resection. Methods In this single-center retrospective case series, eight patients underwent single-level ACDF at C3-4 by a single surgeon. Four patients received a partial hyoid resection (PHR group) to enhance cephalad exposure, while four underwent the standard approach without resection (non-PHR group). Outcome measures included operative time, radiologic outcomes (prevertebral soft tissue swelling, cage position and rotation, plate position and rotation), and perioperative complications. Results The PHR group had a longer mean operative time compared to the non-PHR group (126.3 vs. 98.7 min). Radiologic analysis showed slightly increased prevertebral soft tissue swelling in the PHR group (35.5 mm vs. 24.0 mm). However, implant positioning was more accurate in the PHR group, evidenced by reduced cage offset (0.83 mm vs. 1.30 mm), cage rotation (5.6 degrees vs. 11.2 degrees), and plate rotation (4.5 degrees vs. 7.8 degrees). Clinically, the PHR group experienced only one minor complication (distal screw loosening), whereas the non-PHR group had more significant complications including one pharyngeal tear and one superior laryngeal nerve injury. Conclusion Partial hyoid resection appears feasible and safe for enhancing exposure in high cervical ACDF. In this series, it was associated with more favorable implant alignment and fewer traction-related events, suggesting potential advantages of the PHR-assisted anterior retropharyngeal approach (PHR-ARPA) approach in select cases.