Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion – Prevalence and Risk Factors

Alina Huschbeck; Michael Knoop; Adrian Gahleitner; Stefan Koch; Thomas Schrom; Michael Stoffel; Alex Alfieri; Julius Dengler

doi:10.1055/s-0040-1710351

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 508-512
DOI: 10.1055/s-0040-1710351

Original Article

Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion – Prevalence and Risk Factors

Alina Huschbeck

¹Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany

²Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany

,

Michael Knoop

²Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany

,

Adrian Gahleitner

¹Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany

,

Stefan Koch

¹Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany

³Institute of Pathology, Helios Clinic Bad Saarow, Bad Saarow, Germany

,

Thomas Schrom

¹Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany

⁴Department of Otorhinolaryngology, Helios Clinic Bad Saarow, Bad Saarow, Germany

,

Michael Stoffel

⁵Department of Neurosurgery, Helios Clinic Krefeld, Krefeld, Germany

,

Alex Alfieri

⁶Department of Neurosurgery, Winterthur Cantonal Hospital, Wintherthur, Switzerland

⁷Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus, Senftenberg, The Brandenburg Medical School Theodor Fontane, and the University of Potsdam, Germany

,

Julius Dengler

¹Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany

²Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany

› Author Affiliations

Abstract

Background and Study Aims Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors.

Materials and Methods This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery.

Results 214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; p = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient’s age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97).

Conclusions In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics.

Keywords

anterior discectomy and fusion - cervical spine surgery - recurrent laryngeal nerve palsy - vocal cord palsy

Full Text

References

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