Vocal cord palsy after anterior cervical discectomy

• A Novel Option for Revision Medialization: Repeat Reinnervation
• 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
• Predictors of airway, respiratory, and pulmonary complications following elective anterior cervical discectomy and fusion
• Assessment of Acoustic Voice Parameters After Anterior Cervical Discectomy and Fusion
• Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial
• Delayed recurrent laryngeal nerve palsy after anterior cervical discectomy and fusion C5-C7: Case report
• Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion
• Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion - Prevalence and Risk Factors

Dysphagia and vocal cord palsy (VCP) are common complications after anterior cervical discectomy and fusion (ACDF). The reported incidence for both dysphagia and VCP varies in the literature according to the time the assessment is performed after surgery and the method and completeness of the evaluation. When assessment is performed with questionnaires or objective measurement, the incidence of dysphagia ranges widely, from 17.5% to 71% ¹⁾.

Single-institution, retrospective analysis of a prospectively collected database of patients undergoing rACDF was enrolled from September 2010 to July 2021. Of 222 patients enrolled, 109 patients were included in the final analysis. All patients had prior ACDF surgery with planned revision using a single otolaryngologist and single neurosurgeon. MD Anderson Dysphagia Inventory and fiberoptic endoscopic evaluation of swallowing (FEES) were used to assess dysphagia. VCP was assessed using videolaryngostroboscopy.

Results: Seven patients (6.7%) developed new postoperative VCP after rACDF. Most cases of VCP resolved by 3 months postoperatively (mean time-to-resolution 79 ± 17.6 days). One patient maintained a permanent deficit. Forty-one patients (37.6%) reached minimum clinically important difference (MCID) in their MD Anderson Dysphagia Inventory composite scores at the 2-week follow-up (MCID decline of ≥6), indicating new clinically relevant swallowing disturbance. Forty-nine patients (45.0%) had functional FEES Performance Score decline. On univariate analysis, there was an association between new VCPs and the number of cervical levels treated at revision (P = .020) with long-segment rACDF (≥4 levels) being an independent risk factor (P = .010). On linear regression, there was an association between the number of levels treated previously and at revision for FEES Performance Score decline (P = .045 and P = .002, respectively). However, on univariate analysis, sex, age, body mass index, operative time, alcohol use, smoking, and individual levels revised were not risk factors for reaching FEES Performance Score decline nor MCID at 2 weeks postoperatively.

Conclusion: VCP is more likely to occur in long-segment rACDF but is often temporary. Clinically relevant and functional rates of dysphagia approach 37% and 45%, respectively, at 2 weeks postoperatively after rACDF ²⁾.

The etiology of VCP following ACDF relates to injury to the recurrent laryngeal nerve (RLN), whereas the etiology of dysphagia is less certain.

VCP may be due to sectioning or retraction injury of the RLN, retraction of the esophagus with reduced perfusion ³⁾.