| Summary: | Background: The surgical approach of an anterior cervical discectomy and fusion (ACDF) navigates many important neurologic and vascular structures in the neck. More frequently reported complications are dysphagia, postoperative hematoma, cerebrospinal fluid leaks, and dysphonia. Case description: This case report details an ACDF in a 49-year-old female with intractable neck pain and radicular symptoms. Following the procedure, she developed intermittent tachycardia at rest, which worsened with exertion. Outcome: The cardiac workup was negative. A neck ultrasound demonstrated hypoechoic thickening of the vagus nerve, providing the diagnosis of vagus nerve injury. The patient's tachycardia has been managed with beta-blockers. Conclusions: Although previously unreported, vagus nerve injury following ACDF is possible, causing sympathetic disruption, which can be managed with beta blockers.
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