Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Erwood, Matthew S; Hadley, Mark N.; Gordon, Amber S.; Carroll, William R.; Agee, Bonita S.; Walters, Beverly C.

doi:10.3171/2015.9.spine15187

Cited by 29 publications

(18 citation statements)

References 21 publications

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“…As mentioned previously, the current literature documents an estimate of RLN injury of 14.1%. 16 Therefore, the major finding of this study is that when a 2-team surgical approach is applied to patients undergoing reoperative ACDF (those typically described as being at increased risk for VCP complications), these patients do not develop VCP complications at an increased rate. This finding supports the notion that a 2-team approach using an experienced head and neck surgeon can provide safe transcervical access for reoperative ACDF in patients at high risk for VCP.…”

Section: Discussionmentioning

confidence: 99%

“…In that study the authors included a total of 238 patients in their analysis and concluded that the estimate of 14.1% for RLN palsy in reoperative ACDF surgery was greater than any estimated rate for primary procedures. 16 Although this provides a useful estimate, the limitations of the meta-analysis for estimating the rate of VCP are obvious. Without direct visualization of the vocal cords, accurate assessments of RLN injury and dysphonia are not attainable.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the rate of dysfunction was estimated at approximately 14.1%, which suggested that patients undergoing reoperative ACDF were more susceptible to RLN injury. 16 In addition, the literature to date does not assess the usefulness of a 2-team surgical approach, with exposure done by otolaryngologists for reoperative surgeries.…”

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confidence: 99%

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Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEDysphagia and vocal cord palsy (VCP) are common complications after anterior cervical discectomy and fusion (ACDF). The reported incidence rates for dysphagia and VCP are variable. When videolaryngostroboscopy (VLS) is performed to assess vocal cord function after ACDF procedures, the incidence of VCP is reported to be as high as 22%. The incidence of dysphagia ranges widely, with estimates up to 71%. However, to the authors’ knowledge, there are no prospective studies that demonstrate the rates of VCP and dysphagia for reoperative ACDF. This study aimed to investigate the incidence of voice and swallowing disturbances before and after reoperative ACDF using a 2-team operative approach with comprehensive pre- and postoperative assessment of swallowing, direct vocal cord visualization, and clinical neurosurgical outcomes.METHODSA convenience sample of sequential patients who were identified as requiring reoperative ACDF by the senior spinal neurosurgeon at the University of Alabama at Birmingham were enrolled in a prospective, nonrandomized study during the period from May 2010 until July 2014. Sixty-seven patients undergoing revision ACDF were enrolled using a 2-team approach with neurosurgery and otolaryngology. Dysphagia was assessed both preoperatively and postoperatively using the MD Anderson Dysphagia Inventory (MDADI) and fiberoptic endoscopic evaluation of swallowing (FEES), whereas VCP was assessed using direct visualization with VLS.RESULTSFive patients (7.5%) developed a new postoperative temporary VCP after reoperative ACDF. All of these cases resolved by 2 months postoperatively. There were no new instances of permanent VCP. Twenty-five patients had a new swallowing disturbance detected on FEES compared with their baseline assessment, with most being mild and requiring no intervention. Nearly 60% of patients showed a decrease in their postoperative MDADI scores, particularly within the physical subset.CONCLUSIONSA 2-team approach to reoperative ACDF was safe and effective, with no new cases of VCP on postoperative VLS. Dysphagia rates as assessed through the MDADI scale and FEES were consistent with other published reports.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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“…Advantages of PCF are that the route of approach avoids the possible serious complications that can be accompanied with ACDF, such as injury to the carotid artery, the esophagus or recurrent laryngeal nerve [3][4][5]. PCF also allows to preserve mobility of the treated vertebral segments and does not include the use of implants.…”

Section: Introductionmentioning

confidence: 99%

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands.

Broekema

Groen

Tegzess

et al. 2019

Preprint

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Background For cervical foraminal nerve root decompression, anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) can be applied. Amongst neurosurgeons, there seems to be a tendency to prefer ACDF over PCF, even though there are some advantages in favor of PCF. The object of present study is to evaluate which factors determine the choice for an anterior or posterior surgical approach in patients with a cervical radicular syndrome based on foraminal pathology. Methods A web-based survey was sent to all 133 neurosurgeons in the Netherlands. The first part focused on general perceived (dis)advantages of ACDF and PCF. The second part concerned questions about the choice between the two procedures. Furthermore, it was analyzed if exposure during training, amount of performed surgeries, assumed reoperation and complication rates influenced the choice of procedure by conducting Chi-square tests with post-hoc analysis. Results A total of 56 neurosurgeons responded (42%). Of these, 77% performed more than 10 ACDF and 25% more than 10 PCF annually. An overall preference for ACDF was observed, even when differentiating for a pure disc prolapse, a spondylotic or a combined stenosis. The most relative important factors for motivating the preference for either ACDF or PCF were: the assumed best decompression of the nerve root (18%), perceived congruence with current literature (16%), exposure during residency (12%), personal comfort with the procedure (11%), and experience with the technique (11%). Conclusions In this survey, there was an overall preference for ACDF above PCF for the surgical treatment of a foraminal cervical radiculopathy. In addition to subjective factors as “experience” and “ comfort” with the procedure, the respondents often motivated their choice as “the best one according to literature”. As there is currently no evidence about the superiority of any of the procedures in literature, this assumption is remarkable.

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“…However, oropharyngeal complications after ACDF such as dysphagia, hoarseness, or esophageal perforation may be still underestimated although they have been discussed in the literature. [ 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] Their frequency, severity, and possible eventual recovery after surgery need to be carefully considered. The purpose of this study is to investigate the incidence, severity, and possible risk factors for postoperative dysphagia recognized within 30 days after 1- or 2-level ACDF using a rectangular titanium stand-alone cage.…”

Section: Introductionmentioning

confidence: 99%

Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

Yamagata

Naito

Yoshimura

et al. 2017

J Craniovert Jun Spine

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Background:Postoperative oropharyngeal complications such as dysphagia after anterior cervical spine surgery are some of the least discussed surgery-related complications. The purpose of this retrospective study is to investigate the incidence and possible risk factors for 30-day postoperative dysphagia after anterior cervical discectomy and fusion (ACDF).Materials and Methods:This study included 152 consecutive patients who underwent 1- or 2-level ACDF using a rectangular titanium stand-alone cage in our institutes. Surgery-related dysphagia early after surgery was analyzed based on hospital charts. Radiological evaluation of prevertebral soft tissue swelling (PSTS) was performed by comparing plain lateral radiographs of the cervical spine before surgery with those after surgery. The percentage of PSTS (%PSTS) was defined by retropharyngeal soft tissue diameter divided by vertebral diameter. Positive %PSTS was determined when %PSTS exceeded its mean + 2 standard deviations.Results:Twelve patients (7.9%) demonstrated prolonged symptoms of dysphagia within 30-day postoperatively. All patients eventually demonstrated satisfactory or acceptable recovery late after surgery, except one case of hypoglossal nerve palsy. %PSTS was significantly highest early after surgery and returned to presurgical levels within 30 days after surgery. Statistical analysis suggested that the positive %PSTS at C3 or C4 level early after surgery was significantly associated with the occurrence of postoperative dysphagia.Conclusions:Although the possible reasons for postoperative dysphagia may not only be multifactorial but also be highly surgeon-dependent, such a complication is still underestimated and needs to be carefully resolved. %PSTS appeared to be easy and reliable index to judge the possible risk of postoperative dysphagia.

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Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Cited by 29 publications

References 21 publications

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands.

Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

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