Hyoid Bone Fracture in a Patient as a Rare Cause of Persistent Postoperative Dysphagia Following Anterior Cervical Discectomy and Fusion

Objective:Unusual clinical course Background:Anterior cervical discectomy and fusion (ACDF) is widely used to treat cervical spondylosis, disc herniation, and degenerative disc disease that can cause neck pain, spinal stenosis, radiculopathy, and myelopathy.Dysphagia is a common complication following ACDF.In most cases this symptom is fleeting and resolves within weeks to months of surgery.However, severe and persistent cases of dysphagia do occur, and when they occur, they are rarely attributed to a hyoid fracture.Case Report:We report the case of a 76-year-old woman who developed severe, persistent dysphagia and progressive odynophagia following a C3-5 ACDF.Despite initial treatment with oral steroids and a modified liquid diet, her symptoms worsened.By postoperative day 14 she could not swallow, had lost 4.5 kg in weight, and had a persistent cough.A computed tomography (CT) scan revealed a nondisplaced hyoid fracture.She required inpatient admission for IV hydration, steroids, and swallow therapy education.A percutaneous endoscopic gastrostomy (PEG) tube was recommended, but the patient declined.Her swallowing gradually improved with conservative management.By 10 weeks postoperatively, she demonstrated mild dysphagia on barium swallow, and at 5 months she had complete resolution of symptoms, with confirmed radiographic fusion. Conclusions:Although dysphagia is common after ACDF, hyoid bone fracture is a rare but clinically important potential contributor to severe and persistent symptoms.A hyoid fracture should be considered in the differential diagnosis when dysphagia worsens or does not improve with standard therapy.CT imaging is essential to establish the diagnosis and guide management.