skip to main content

RLN Injury ACDF Surgery — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuroanaesthesiaRLN Injury ACDF SurgeryFRCA Final

A 42-year-old woman (ASA II, 70 kg) is undergoing anterior cervical discectomy and fusion (ACDF) at C5/6 under general anaesthesia. The surgeon uses a right-sided anterior approach. Post-extubation the patient has a hoarse voice. Which nerve is most likely to have been injured by the surgical approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Right recurrent laryngeal nerve

The right recurrent laryngeal nerve is at risk during anterior cervical spine surgery via a right-sided approach because it loops under the subclavian artery and ascends in the tracheo-oesophageal groove, making it vulnerable to retraction injury. The left RLN loops under the aortic arch and ascends in a more protected position. Some surgeons prefer a left-sided approach at lower cervical levels for this reason, while right-sided approaches are preferred at C3-C4 (to avoid the thoracic duct). Hoarseness from unilateral RLN injury is usually temporary.

Reference: NACCS – 2023 – Neuroanaesthesia guidelines; RCOA – 2023 – Head and neck/neuroanaesthesia