Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion

A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade

Background

Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications.

Objective

To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research.

Methods

To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria.

Results

The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%.

Conclusion

Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.

The effectiveness of reducing endotracheal cuff pressure after retractor placement to decrease postoperative laryngeal dysfunction in anterior cervical surgery: a meta-analysis

OBJECTIVE

The authors sought to determine if a consensus could be reached regarding the effectiveness of endotracheal tube cuff pressure (ETTCP) reduction after retractor placement in reducing postoperative laryngeal dysfunction after anterior cervical fusion surgery.

METHODS

A literature search of MEDLINE (PubMed), EMBASE, Cochrane Central, Google Scholar, and Scopus databases was performed. Quantitative analysis was performed on data from articles comparing groups of patients with either reduced or unadjusted ETTCP after retractor placement in the context of anterior cervical surgery. The incidence and severity of postoperative recurrent laryngeal nerve palsy (RLNP), dysphagia, and dysphonia were compared at several postsurgical time points, ranging from 24 hours to 3 months. Heterogeneity was assessed using the chi-square test, I2 statistics, and inverted funnel plots. A random-effects model was used to provide a conservative estimate of the level of effect.

RESULTS

Nine studies (7 randomized, 1 prospective, and 1 retrospective) were included in the analysis. A total of 1671 patients were included (1073 [64.2%] in the reduced ETTCP group and 598 [35.8%] in the unadjusted ETTCP group). In the reduced ETTCP group, the severity of dysphagia, measured by the Bazaz-Yoo system in 3 randomized studies at 24 hours and at 4-8 weeks, was significantly lower (24 hours [standardized mean difference: -1.83, p = 0.04] and 4-8 weeks [standardized mean difference: -0.40, p = 0.05]). At 24 hours, the odds of developing dysphonia were significantly lower (OR 0.51, p = 0.002). The odds of dysphagia (24 hours: OR 0.77, p = 0.24; 1 week: OR 0.70, p = 0.47; 12 weeks: OR 0.58, p = 0.20) were lower, although not significantly, in the reduced ETTCP group. The odds of a patient having RLNP were significantly lower at all time points (24 hours: OR 0.38, p = 0.01; 12 weeks: OR 0.26, p = 0.03) when 3 randomized and 2 observational studies were analyzed. A subgroup analysis using only randomized studies demonstrated a similar trend in odds of having RLNP, yet without statistical significance (24 hours: OR 0.79, p = 0.60). All other statistically significant findings persisted with removal of any observational data.

CONCLUSIONS

Based on the current best available evidence, reduction of ETTCP after retractor placement in anterior cervical surgery may be a protective measure to decrease the severity of dysphagia and the odds of developing RLNP or dysphonia.

Anterior servikal omurga cerrahisi sonrası farklı endotrakeal tüp kaf basınçlarının disfajı üzerine etkileri

Amaç: Bu çalışmada, anterior servikal omurga cerrahisinde iki farklı endotrakeal kaf basıncının postoperatif disfaji, boğaz ağrısı, disfoni ve hastanede kalış üzerindeki etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Cerrahi planlanan 70 hasta rastgele iki gruba ayrıldı. Entübasyondan sonra endotrakeal kaf basıncı Grup I'de (n=35) ve Grup II'de (n=35) sırasıyla 20 cmH2O ve 25 cmH2O'ya şişirildi. Disfajinin derecesi Bazaz disfaji skoru ile değerlendirildi. Boğaz ağrısı Görsel Analog Skala ile değerlendirildi. Operasyon bölgesine ilişkin toplam ağrı skoru VAS kullanılarak değerlendirildi (. Ses kısıklığı, seste herhangi bir değişiklik olup olmamasına göre sert veya gergin olarak değerlendirildi. Disfaji, disfoni ve boğaz ağrısı ameliyat sonrası 1. ve 24. saatlerde değerlendirildi. Bulgular: Gruplar arasında demografik verilerde farklılık yoktu. Ameliyat sonrası 1. ve 24. saatlerde yutma güçlüğü ve boğaz ağrısı Grup I'de Grup II'ye göre anlamlı olarak daha azdı. Disfoni sıklığı Grup I'de Grup II'ye kıyasla sadece cerrahi sonrası 1. saatte anlamlı olarak daha azdı. Gruplar arasında ameliyat sonrası 1. ve 24. saatlerde VAS skorlarında fark yoktu. Sonuç: Bu çalışmada, 25 cmH2O'ya kıyasla endotrakeal kaf basıncı 20 cmH2O ile cerrahi sonrası disfaji gelişme riskinin önemli ölçüde azalttığı gösterilmiştir. Ayrıca, daha düşük kaf basıncı, daha hafif bir boğaz ağrısı, ameliyat sonrası 1. saatte daha az ses kısıklığı ve daha kısa hastanede kalış süresi ile ilişkilendirildi.