Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery

Abstract

Objective To report on the incidence of dysphagia, dysphonia, and acute vocal fold motion impairment (VFMI) following revision anterior cervical spine surgery, as well as to identify risk factors associated with acute VFMI in the immediate postoperative period. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods All patients who underwent 2-team reoperative anterior cervical discectomy and fusion (ACDF) were retrospectively reviewed. Incidence of dysphonia, dysphagia, and acute VFMI was noted. Patient and operative factors were evaluated for association with risk of acute VFMI. Results The incidence of postoperative dysphonia and dysphagia was 25% (18/72) and 52% (37/72), respectively. The incidence of immediate VFMI was 21% (15/72). Subjective postoperative dysphonia (odds ratio, [OR] 8; 95% CI, 2.2-28; P = .001) and dysphagia (OR, 22; 95% CI, 2.5-168; P = .005) were significantly associated with increased risk of VFMI. Three patients with VFMI required temporary injection medialization for voice complaints and/or aspiration. Infection (OR, 14; 95% CI, 1.4-147, P = .025) and level C7/T1 (OR, 5.5; 95% CI, 1.3-23, P = .02) were significantly associated with an increased risk of acute VFMI on multivariate logistic regression analysis. Number of prior surgeries, laterality of approach, side of approach relative to prior operations, and number of levels exposed were not significant. Conclusion Early involvement of an otolaryngologist in the care of a patient undergoing revision ACDF can be helpful to the patient in anticipation of voice and swallowing changes in the postoperative period. This may be particularly important in those being treated at C7/T1 or those with spinal infections.

Early Voice and Swallowing Disturbance Incidence and Risk Factors After Revision Anterior Cervical Discectomy and Fusion Using a Multidisciplinary Surgical Approach: A Retrospective Cohort Evaluation of a Prospective Database

“…They reported an immediate postoperative dysphagia incidence of 52% (24-48 hours). 12 In both of these studies, the immediate and early 2-week incidence rates are similar to slightly higher than both the functional and PROMs found in our study (45.0% and 37.6%, respectively).…”

“…However, these revisions often require sharper and wider dissection to release tension on adherent anatomy to minimize the risk of retraction injury to the recurrent laryngeal nerve (RLN), esophagus, or vascular structures in the neck. 11,12,16 This can be especially difficult if the patient has had more than 1 revision transcervical approach. It is advantageous to have an experienced and knowledgeable head and neck surgeon, who has performed countless neck dissections, assist with dissection where identification, dissection, and protection of distorted anatomy is critical to the success of the approach.…”

“…11 Since its completion, a few other studies have retrospectively examined otolaryngological complications after rACDF procedures. 12,13 Despite these studies, there remains a need in the literature to better understand and manage dysphagia and VCP after revision anterior cervical spine surgery.…”

The Effect of Vocal Intonation Therapy on Vocal Dysfunction in Patients With Cervical Spinal Cord Injury: A Randomized Control Trial

“…Since singing and speaking share the same neural network, in recent years, an increasing number of studies have focused on the treatment of speech abnormalities caused by functional disorders of the nervous system ( Jasmin et al, 2016 ). Vocal vocalization therapy (VIT) ( Thaut and Hoemberg, 2014 ) uses vocal music training to practice vocal function control problems caused by structural, neurological, physiological, psychological, or functional abnormalities of vocal organs ( Strohl et al, 2020 ). VIT directly stimulates the muscles associated with breathing, vocalization, articulation, and resonance and requires more sound control ( Scheuren et al, 2021 ) and intensity ( Rodrigues et al, 2021 ) than speech.…”