Intraoperative Monitoring of the Recurrent Laryngeal Nerve with Electromyography Endotracheal Tube in Anterior Cervical Discectomy and Fusion

Dysphagia following anterior cervical spine surgery (ACSS) poses a significant clinical challenge, with recurrent laryngeal nerve (RLN) injury emerging as a potential contributor. This case report describes the case of a 55-year-old male who underwent ACSS and subsequently developed dysphagia and hoarseness due to left RLN damage. Employing videofluoroscopic swallowing study (VFSS)-guided balloon dilatation on postoperative day 12, we observed a notable improvement in the opening of the upper esophageal sphincter (UES), as validated by a follow-up VFSS. The patient successfully transitioned from total parenteral nutrition to oral intake, demonstrating the clinical significance of the intervention. Although promising, long-term follow-up studies are warranted to assess the sustained efficacy of VFSS-guided balloon dilatation and the potential recurrence of dysphagia. Safety considerations and protocol variations merit further investigation, emphasizing the need for collaborative multicenter studies. In conclusion, VFSS-guided balloon dilatation is a potentially effective treatment for post-ACSS dysphagia associated with UES dysfunction caused by RLN injury.

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Precision and protection: advancements and future of neuromonitoring techniques for laryngeal surgery

Padalhin

2024

J Neuromonit Neurophysiol

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Intraoperative neuromonitoring (IONM) has improved the safety of laryngeal surgeries by protecting critical nerves such as the recurrent laryngeal nerve and vagus nerve. This review traces the evolution of neuromonitoring from its late 19th-century origins to the modern era, focusing on the transition from intermittent intraoperative neuromonitoring (I-IONM) to continuous intraoperative neuromonitoring (cIONM). Unlike I-IONM, which offers periodic nerve activity snapshots, cIONM provides continuous, real-time feedback throughout surgery, improving nerve injury detection and prevention. Advances in electromyography (EMG) techniques and the laryngeal adductor reflex have been key in this progression. The integration of endotracheal tube-based systems has revolutionized monitoring by providing less invasive and more accurate assessments. The review also explores cIONM's role in minimally invasive surgeries, such as robotic and endoscopic procedures, offering enhanced precision and better patient outcomes. It further discusses recent advancements in EMG techniques and future directions, highlighting the potential for innovations to enhance the precision and safety of laryngeal surgeries.

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve with Electromyography Endotracheal Tube in Anterior Cervical Discectomy and Fusion

Cited by 4 publications

References 20 publications

Surgical approaches I—Cervical spine

Surgical approaches I—Cervical spine

Videofluoroscopic Swallowing Study-Guided Balloon Dilatation for Dysfunction of the UES

Precision and protection: advancements and future of neuromonitoring techniques for laryngeal surgery

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