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Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study

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Abstract

Prediction of vocal cord dysfunction is essential after anterior cervical spine surgeries. This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. Rigid laryngoscopy was the standard confirmatory tool. For postoperative vocal cord edema, the anterior ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 78.9% with PPV = 78.9% and NPV = 88.2% and the novel lateral ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 94.7% with PPV = 93.75% and NPP = 90%. While for paralysis, the anterior ultrasonography approach diagnostic sensitivity = 86.7%, specificity = 85.7% with PPV = 81.25% and NPV = 90% and the novel lateral ultrasonography approach diagnostic (sensitivity, specificity with PPV and NPP) = 100%. The diagnostic accuracy of the novel lateral approach was more correlated to rigid laryngoscopy (91.7% and 100%) compared to anterior approach for vocal cord edema and paralysis (83.3% and 80.6%). Overall incidence of vocal cord paralysis was 16.6%. Risk of vocal cord paralysis was statistically significant more in female, multiple disc herniation, lower and mixed disc levels, Langenbeck retractor, cage and plate and duration of surgery ≥ 1.5 h. Transcutaneous Laryngeal ultrasound is a valid comfortable tool for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries with superiority of the novel lateral over anterior approach.

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Authors and Affiliations

  1. Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt

    Alshaimaa Abdel Fattah Kamel, Olfat Abdelmoniem Ibrahem Amin & Mohyieldin Abdou Mohyieldin Moustafa Hassan

  2. Neurosurgery Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt

    Wael Abd Elrahman Ali Elmesallamy

  3. Phoniatrics at Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt

    Elham Magdy Hassan

Authors
  1. Alshaimaa Abdel Fattah Kamel
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  2. Olfat Abdelmoniem Ibrahem Amin
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  3. Mohyieldin Abdou Mohyieldin Moustafa Hassan
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  4. Wael Abd Elrahman Ali Elmesallamy
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  5. Elham Magdy Hassan
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Contributions

AAFK This author helped in registration, conception, collecting data, creating the ultrasound images and video and designing the study. OAIA. This author helped in design the study, analyzing data and approving the final manuscript. MAMMH. This author helped in designing the study and creating the ultrasound images and video. WAEEAE. This author helped in performing the surgeries, designing the study and Follow up the patient’s clinical. EMH. This author helped in performing the laryngoscopy examination and approving final manuscript.

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Correspondence to Alshaimaa Abdel Fattah Kamel.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University’s Institutional Review Board (IRB #5645-15-1-2019) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was registered at clinicaltrial.gov (NCT04140799, Date of registration: 23 october 2019).

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Written informed consent was obtained from all subjects participating in the study.

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Electronic supplementary material

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Video that demonstrates the normal symmetrical ultrasound vocal cord movement by anterior approach. Supplementary file1 (MP4 2170 kb)

Video that demonstrates left vocal cord paralysis by anterior approach. Supplementary file2 (MP4 4876 kb)

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Kamel, A.A.F., Amin, O.A.I., Hassan, M.A.M.M. et al. Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study. J Clin Monit Comput 35, 869–875 (2021). https://doi.org/10.1007/s10877-020-00546-3

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  • DOI: https://doi.org/10.1007/s10877-020-00546-3

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