Delayed Recurrent Laryngeal Nerve Palsy Following Anterior Cervical Discectomy and Fusion

Yerneni, Ketan; Burke, John F.; Nichols, Noah; Tan, Lee A.

doi:10.1016/j.wneu.2018.11.066

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…a 75-year-old female, 3 days after a C4-7 ACDF, developed a delayed recurrent laryngeal nerve palsy (RLNP) [Table 3]. [21] The left vocal cord paralysis was treated with a course of steroids, and 6 months later, her deficit resolved. The most likely etiology of the delayed RLNP was “neurapraxia caused by intraoperative compression or traction on the nerve”, but other potential factors included; direct nerve injury, ischemia, vasospasm, or viral factors…”

Section: Introductionmentioning

confidence: 99%

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Epstein

2019

Surgical Neurology International

228

167

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Background: There are multiple complications reported for anterior cervical diskectomy and fusion (ACDF), one of the most common cervical spine operations performed in the US (e.g. estimated at 137,000 ACDF/year). Methods: Multiple studies analyzed the risks and complications rates attributed to ACDF. Results: In multiple studies, overall morbidity rates for ACDF varied from 13.2% to 19.3%. These included in descending order; dysphagia (1.7%-9.5%), postoperative hematoma (0.4%-5.6% (surgery required in 2.4% of 5.6%), with epidural hematoma 0.9%), exacerbation of myelopathy (0.2%-3.3%), symptomatic recurrent laryngeal nerve palsy (0.9%-3.1%), cerebrospinal fluid (CSF) leak (0.5%-1.7%), wound infection (0.1-0.9%-1.6%), increased radiculopathy (1.3%), Horner’s syndrome (0.06%-1.1%), respiratory insufficiency (1.1%), esophageal perforation (0.3%-0.9%, with a mortality rate of 0.1%), and instrument failure (0.1%-0.9%). There were just single case reports of an internal jugular veing occlusion and a phrenic nerve injury. Pseudarthrosis occurred in ACDF and was dependant on the number of levels fused; 0-4.3% (1-level), 24% (2-level), 42% (3 level) to 56% (4 levels). The reoperation rate for symptomatic pseudarthrosis was 11.1%. Readmission rates for ACDF ranged from 5.1% (30 days) to 7.7% (90 days postoperatively). Conclusions: Complications attributed to ACDF included; dysphagia, hematoma, worsening myelopathy, recurrent laryngeal nerve palsy, CSF leaks, wound infection, radiculopathy, Horner’s Syndrome, respiratory insufficiency, esophageal perforation, and instrument failure. There were just single case reports of an internal jugular vein thrombosis, and a phrenic nerve injury. As anticipated, pseudarthrosis rates increased with the number of ACDF levels, ranging from 0-4.3% for 1 level up to 56% for 4 level fusions.

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Section: Introductionmentioning

confidence: 99%

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Epstein

2019

Surgical Neurology International

228

167

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“…Most commonly, it presents as hoarseness, cough and dysphagia post operatively. Most symptomatic RLNP present immediately post-operatively, although there have been descriptions of delayed presentations [5]. Patients undergoing revision anterior cervical spine surgery are at a higher risk of suffering from RLNP [4].…”

Section: Discussionmentioning

confidence: 99%

Contralateral recurrent laryngeal nerve palsy in revision anterior cervical discectomy and fusion (ACDF): A cautionary tale

Wu¹,

Yang²,

Lor³

2021

BioMedicine

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Revision anterior cervical spine surgery has a higher risk of recurrent laryngeal nerve palsy (RLNP). We describe a unique case of an isolated RLNP contralateral to the side of the surgical approach in a patient who underwent revision anterior cervical discectomy and fusion (ACDF) for cervical myelopathy, and in whom pre-operative laryngoscopic evaluation had excluded a pre-existing occult RLNP. Scarring around the recurrent laryngeal nerve at the previous surgical site may have rendered it less mobile, resulting in it being more susceptible to compression from an inflated endotracheal tube (ETT) cuff or traction from surgical retractors. This case illustrates that acute RLNP can rarely occur contralateral to the side of surgical approach in the setting of revision surgery. Surgeons performing revision ACDF can consider approaching from the same side as the index surgery or a posterior approach to reduce the risk of developing bilateral RLNP.

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“…Yerneni ve arkadaşları 3 seviye ASDF uygulanmış olan hastalarında postoperatif 3. gün ses kısıklığı sonrası sol vokal kord paralizisi saptamış olup, uygun steroid tedavisi sonrası 6 ayda normale döndüğünü bildirmişlerdir (9) . Olgumuz da 3 seviye ADSF uygulanmış olup, tedavi sonrası bir ayda semptomların ortadan kalkması ile daha kısa sürede kür sağlanmıştır.…”

Section: Discussionunclassified

The Case With Two Rare Complications in Anterior Cervical Discectomy and Fusion

Öztürk¹,

Dağlar²,

Cömert

et al. 2021

SSCD

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Anterior cervical discectomy and fusion is the most widely used vertebral instrumentation procedure. In this report, we present a patient with suspected vertebral artery injury and vocal cord paralysis complications after ASDF operation. In order to minimize these complications, it is aimed to emphasize the importance of careful management of radiological imaging and complication management due to surgical anatomy differences.

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Delayed Recurrent Laryngeal Nerve Palsy Following Anterior Cervical Discectomy and Fusion

Cited by 13 publications

References 17 publications

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Contralateral recurrent laryngeal nerve palsy in revision anterior cervical discectomy and fusion (ACDF): A cautionary tale

The Case With Two Rare Complications in Anterior Cervical Discectomy and Fusion

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