Is dysphonia permanent or temporary after anterior cervical approach?
- 216 Downloads
- 19 Citations
Abstract
The rate, causes and prognosis of dysphonia after anterior cervical approach (ACA) were investigated in our clinical series. During a 10-year interval, 235 consecutive patients with cervical disc disease underwent surgical treatment using anterior approach. Retrospective chart reviews showed recurrent laryngeal nerve (RLN) injury in 3 (1.27%) patients. All three patients were men and only one patient had multilevel surgery. These patients had RLN injury after virgin surgery. Laryngoscopic examination demonstrated unilateral vocal cord paralysis in all patients who had postoperative dysphonia. No permanent dysphonia was observed in our series and patients recovered after a mean of 2 months (range 1–3 months) duration. Dysphonia after ACA was a rare complication in our clinical series. Pressure on RLN or retraction may result in temporary dysphonia.
Keywords
Cervical surgery Dysphonia Prognosis Recurrent laryngeal nerveReferences
- 1.Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery. A prospective study. Spine 27(22):2453–2458PubMedCrossRefGoogle Scholar
- 2.Bertalanffy H, Eggert H (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99:41–50CrossRefGoogle Scholar
- 3.Bulger RF, Rejowski JE, Beatty RA (1985) Vocal fold paralysis associated with anterior cervical fusion: considerations for prevention and treatment. J Neurosurg 62:657–661PubMedGoogle Scholar
- 4.Cavo JW (1985) True vocal fold paralysis following intubation. Laryngoscope 95:1352–1358PubMedCrossRefGoogle Scholar
- 5.Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617PubMedCrossRefGoogle Scholar
- 6.Cloward RB (1962) New method of diagnosis and treatment of cervical disc disease. Clin Neurosurg 8:93–132PubMedGoogle Scholar
- 7.Dohn DF (1966) Anterior interbody fusion for treatment of cervical-disk conditions. JAMA 197:175–178CrossRefGoogle Scholar
- 8.Ebraheim NA, Lu J, Skie M et al (1997) Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine. Spine 22:2663–2667Google Scholar
- 9.Flynn TB (1982) Neurologic complications of anterior cervical interbody fusion. Spine 7:536–539PubMedCrossRefGoogle Scholar
- 10.Flynn TB (1987) Neurological complications of anterior cervical discectomy and interbody fusion: 1974 vs. 1984. Neurosurgery 21:119Google Scholar
- 11.Frempong-Boadu A, Houten JK, OsbornB, Opulencia J, Kells L, Guida DD, LeRoux PD (2002) Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 15(5):362–368PubMedGoogle Scholar
- 12.Geiger M, Roth PA, Wu JK (1995) The anterior cervical approach to the cervicothoracic junction. Neurosurgery 37:704–709CrossRefGoogle Scholar
- 13.Grisoli F, Graziani N, Fabrizi AP, Peragut JC, Vincentelli F, Diaz-Vasquez P (1989) Anterior discectomy without fusion for treatment of cervical lateral soft disc extrusion: a follow-up of 120 cases. Neurosurgery 24:853–858PubMedCrossRefGoogle Scholar
- 14.Heeneman H (1973) Vocal fold paralysis following approaches to the anterior cervical spine. Laryngoscope 83:17–21PubMedCrossRefGoogle Scholar
- 15.Jain KK (1974) Anterior approach to the cervical spine. Can Med Assoc J 111:49–50PubMedGoogle Scholar
- 16.Jensen R, Jellis HWS, Thaliji Z et al (1998) Intraoperative recurrent laryngeal nerve monitoring during anterior cervical spine procedures with posterior pharyngeal electromyography. Annu Meeting Am Acad Neurosurg 133 (Abstract)Google Scholar
- 17.Kriskovich MD, Apfelbaum RI, Haller JR (2000) Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury. Laryngoscope Sep 110(9):1467–1473CrossRefGoogle Scholar
- 18.Lim EK, Chia KS, Ng BK (1987) Recurrent laryngeal nerve palsy following endotracheal intubation. Anesth Intensive Care 15:342–345Google Scholar
- 19.Mayfield FH (1966) Cervical spondylosis: a comparison of the anterior and posterior approaches. Clin Neurosurg 13:181–187Google Scholar
- 20.Menck J, Gruber J, Lierse W (1990) Anterior approach to the cervical vertebrae and the location of the recurrent laryngeal nerve. Unfallchirurg 93:384–386PubMedGoogle Scholar
- 21.Netterville JL, Koriwchak MJ, Winkle M, Courey MS, Ossi RH (1996) Vocal fold paralysis following anterior approach to the cervical spine. Ann Otol Rhinol Laryngol 105:85–91PubMedGoogle Scholar
- 22.O’Shea J, Sundaresan N, Steinberger AA, Moore F (1996) Surgical approaches to the cervicothoracic junction. In: Menezes AH, Sonntag VKH (eds) Principles of spinal surgery. McGraw-Hill, New York, pp 1253–1261Google Scholar
- 23.Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for the cervical disc syndrome. Bull John Hopkins Hosp 96:223–224Google Scholar
- 24.Sidhu KS, Herkowitz HH (1999) Surgical management of cervical spine disease. In: Herkowitz HN, Garfin SR, Balderston RA, Eismont FJ, Bell GR, Wiesel SW (eds) The spine. W.B. Saunders, Philadelphia, pp 501–510Google Scholar
- 25.Sperry RJ, Johnson JO, Apfelbaum RI (1993) Endotracheal tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system. Anesth Analg 76:1318–1321PubMedGoogle Scholar
- 26.Tew JM, Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23:424–434PubMedGoogle Scholar
- 27.Watters WC, Levinthal R (1994) Anterior cervical discectomy with and without fusion. Spine 19:2343–2347PubMedGoogle Scholar
- 28.Weisberg NK, Spangler DM, Netterville JL (1997) Stretch-induced nerve injury as a cause of paralysis secondary to the anterior cervical approach. Otolaryngol Head Neck Surg 116:317–326PubMedCrossRefGoogle Scholar
- 29.Winslow CP, Meyers AD (1999) Otolaryngologic complications of the anterior approach to the cervical spine. Am J Otolaryngol 20:16–27PubMedCrossRefGoogle Scholar
- 30.Yamamoto I, Ikeda A, Shibuya N, Tsugane R, Sato O (1991) Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine 16:272–279PubMedCrossRefGoogle Scholar
- 31.Yue WM, Brodner W, Highland TR (2005) Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5 to 11 year follow-up study. Eur Spine J Sep 14(7):677–682CrossRefGoogle Scholar
- 32.Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine Oct 1 30(19):2138–2144CrossRefGoogle Scholar
- 33.Zeidman SM, Ducker TB, Raycroft J (1997) Trends and complications in cervical spine surgery: 1989–1993. J Spinal Disord 10:523–526PubMedCrossRefGoogle Scholar