• Hjorleifur Skorri Thormodsson, Eleftherios Ntouniadakis, Marek Holy, and Freyr Gauti Sigmundsson.
• Department of Orthopedic Surgery, Örebro University Hospital, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address: hjorleifur.thormodsson@regionorebrolan.se.
• World Neurosurg. 2020 Nov 1; 143: 360-364.

BackgroundAcute bilateral vocal fold paralysis is a life-threatening complication that can occur during spinal surgery but has almost exclusively occurred with anterior approaches. Bilateral vocal fold paralysis after posterior spinal surgery has been exceedingly rare.Case DescriptionWe present a case of acute postoperative dyspnea due to vocal fold paralysis requiring intubation and surgical intervention after posterior spinal correction for the treatment of dropped head syndrome. The patient had had a previous diagnosis of atypical Parkinson disease but was later diagnosed with multiple system atrophy.ConclusionsWe suggest that multiple system atrophy can result in an increased risk of bilateral vocal fold paralysis during surgical intervention of dropped head syndrome. Thus, our report could be of interest for those who perform spinal surgery in patients with neurological conditions.Copyright © 2020 Elsevier Inc. All rights reserved.

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