Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion – Prevalence and Risk Factors
Background and Study Aims Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors.
Materials and Methods This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery.
Results 214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; p = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient’s age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97).
Conclusions In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics.
Keywordsanterior discectomy and fusion - cervical spine surgery - recurrent laryngeal nerve palsy - vocal cord palsy
Received: 17 September 2019
Accepted: 02 December 2019
10 August 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Flynn TB. Neurologic complications of anterior cervical discectomy in Louisiana. J La State Med Soc 1984; 136 (07) 6-8
- 2 Kriskovich MD, Apfelbaum RI, Haller JR. Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury. Laryngoscope 2000; 110 (09) 1467-1473
- 3 Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine 2000; 25 (22) 2906-2912
- 4 Gokaslan ZL, Bydon M, De la Garza-Ramos R. et al. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study. Global Spine J 2017; 7 (01) 53S-57S
- 5 Heese O, Schröder F, Westphal M, Papavero L. Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part I: pressure. Eur Spine J 2006; 15 (12) 1833-1837
- 6 Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study. Neurosurgery 2010; 67 (01) 10-15 , discussion 15
- 7 Tan TP, Govindarajulu AP, Massicotte EM, Venkatraghavan L. Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review. Spine J 2014; 14 (07) 1332-1342
- 8 Dimopoulos VG, Chung I, Lee GP. et al. Quantitative estimation of the recurrent laryngeal nerve irritation by employing spontaneous intraoperative electromyographic monitoring during anterior cervical discectomy and fusion. J Spinal Disord Tech 2009; 22 (01) 1-7
- 9 Danto J, DiCapua J, Nardi D. et al. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol 2012; 24 (04) 350-355
- 10 Zeidman SM, Ducker TB, Raycroft J. Trends and complications in cervical spine surgery: 1989-1993. J Spinal Disord 1997; 10 (06) 523-526
- 11 François JM, Castagnera L, Carrat X. et al. [A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. Rev Laryngol Otol Rhinol (Bord) 1998; 119 (02) 95-100
- 12 Pedram M, Castagnera L, Carat X, Macouillard G, Vital JM. Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone. Eur Spine J 2003; 12 (01) 84-90
- 13 Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 2009; 63 (04) 624-629
- 14 Jung A, Schramm J, Lehnerdt K, Herberhold C. Recurrent laryngeal nerve palsy during anterior cervical spine surgery: a prospective study. J Neurosurg Spine 2005; 2 (02) 123-127
- 15 Fountas KN, Kapsalaki EZ, Nikolakakos LG. et al. Anterior cervical discectomy and fusion associated complications. Spine 2007; 32 (21) 2310-2317
- 16 Razfar A, Sadr-Hosseini SM, Rosen CA. et al. Prevention and management of dysphonia during anterior cervical spine surgery. Laryngoscope 2012; 122 (10) 2179-2183
- 17 Mayr MT, Subach BR, Comey CH, Rodts GE, Haid Jr RW. Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 2002; 96 (01) 10-16
- 18 Beutler WJ, Sweeney CA, Connolly PJ. Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality of surgical approach. Spine 2001; 26 (12) 1337-1342
- 19 Kilburg C, Sullivan HG, Mathiason MA. Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury. J Neurosurg Spine 2006; 4 (04) 273-277
- 20 Serpell JW, Yeung MJ, Grodski S. The motor fibers of the recurrent laryngeal nerve are located in the anterior extralaryngeal branch. Ann Surg 2009; 249 (04) 648-652
- 21 Jellish WS, Jensen RL, Anderson DE, Shea JF. Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation. J Neurosurg 1999; 91 (02) 170-174