1
|
Iliadou E, Fortune-Ely M, Melley LE, Garabet R, Sataloff RT, Rubin JS. Patients' Demographics and Risk Factors in Voice Disorders: An Umbrella Review of Systematic Reviews. J Voice 2024:S0892-1997(24)00080-8. [PMID: 38556378 DOI: 10.1016/j.jvoice.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES This study aimed to provide a comprehensive overview of the systematic reviews that focus on the prevalence of voice disorders (VDs), associated risk factors, and the demographic characteristics of patients with dysphonia. An umbrella review was conducted to identify general research themes in voice literature that might guide future research initiatives and contribute to the classification of VDs as a worldwide health concern. STUDY DESIGN Umbrella review of systematic reviews. METHODS Pubmed/Medline and Embase were searched for eligible systematic reviews by two authors independently. Extracted data items included the study publication details, study design, characteristics of the target population, sample size, region/country, and incidence and/or prevalence of the VD(s) of interest. RESULTS Forty systematic reviews were included. Sixteen reported a meta-analysis. Great heterogeneity in methods was found. A total of 277,035 patients across the included studies were included with a prevalence ranging from 0%-90%. The countries represented best were the United States and Brazil, with 13 studies each. Aging, occupational voice use, lifestyle choices, and specific comorbidities, such as obesity or hormonal disorders, seem to be associated with an increased prevalence of dysphonia. CONCLUSIONS This review underscores the influence of VDs on distinct patient groups and the general population. A variety of modifiable or non-modifiable risk factors, having varied degrees of impact on voice qualities, have been identified. The overall effect of VDs is probably underestimated due to factors, such as sample size, patient selection, underreporting of symptoms, and asymptomatic cases. Employing systematic reviews with consistent methodologies and criteria for diagnosing VDs would enhance the ability to determine the prevalence of VDs and their impact.
Collapse
Affiliation(s)
| | | | - Lauren E Melley
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia
| | - Razmig Garabet
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia
| | - Robert T Sataloff
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia
| | - John S Rubin
- University College London Hospital Trust, London, United Kingdom
| |
Collapse
|
2
|
Laskay NMB, Yang LC, Estevez-Ordonez D, Warner JD, Trahan D, Stone C, Grayson JW, Withrow K, Hadley MN. 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. Neurosurgery 2024; 94:444-453. [PMID: 37830799 DOI: 10.1227/neu.0000000000002704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Dysphagia and vocal cord palsy (VCP) are common otolaryngological complications after revision anterior cervical discectomy and fusion (rACDF) procedures. Our objective was to determine the early incidence and risk factors of VCP and dysphagia after rACDF using a 2-team approach. METHODS 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.
Collapse
Affiliation(s)
- Nicholas M B Laskay
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Lydia C Yang
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | | | - Jeffrey D Warner
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Duane Trahan
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Caitlin Stone
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Jessica W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Kirk Withrow
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Mark N Hadley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| |
Collapse
|
3
|
Issa M, Neumann JO, Al-Maisary S, Dyckhoff G, Kronlage M, Kiening KL, Ishak B, Unterberg AW, Scherer M. Anterior Access to the Cervicothoracic Junction via Partial Sternotomy: A Clinical Series Reporting on Technical Feasibility, Postoperative Morbidity, and Early Surgical Outcome. J Clin Med 2023; 12:4107. [PMID: 37373799 DOI: 10.3390/jcm12124107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Surgical access to the cervicothoracic junction (CTJ) is challenging. The aim of this study was to assess technical feasibility, early morbidity, and outcome in patients undergoing anterior access to the CTJ via partial sternotomy. Consecutive cases with CTJ pathology treated via anterior access and partial sternotomy at a single academic center from 2017 to 2022 were retrospectively reviewed. Clinical data, perioperative imaging, and outcome were assessed with regards to the aims of the study. A total of eight cases were analyzed: four (50%) bone metastases, one (12.5%) traumatic instable fracture (B3-AO-Fracture), one (12.5%) thoracic disc herniation with spinal cord compression, and two (25%) infectious pathologic fractures from tuberculosis and spondylodiscitis. The median age was 49.9 years (range: 22-74 y), with a 75% male preponderance. The median Spinal Instability Neoplastic Score (SINS) was 14.5 (IQR: 5; range: 9-16), indicating a high degree of instability in treated cases. Four cases (50%) underwent additional posterior instrumentation. All surgical procedures were performed uneventfully, with no intraoperative complications. The median length of hospital stay was 11.5 days (IQR: 9; range: 6-20), including a median of 1 day in an intensive care unit (ICU). Two cases developed postoperative dysphagia related to stretching and temporary dysfunction of the recurrent laryngeal nerve. Both cases completely recovered at 3 months follow-up. No in-hospital mortality was observed. The radiological outcome was unremarkable in all cases, with no case of implant failure. One case died due to the underlying disease during follow-up. The median follow-up was 2.6 months (IQR: 23.8; range: 1-45.7 months). Our series indicates that the anterior approach to the cervicothoracic junction and upper thoracic spine via partial sternotomy can be considered an effective option for treatment of anterior spinal pathologies, exhibiting a reasonable safety profile. Careful case selection is essential to adequately balance clinical benefits and surgical invasiveness for these procedures.
Collapse
Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jan-Oliver Neumann
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sameer Al-Maisary
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Karl L Kiening
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| |
Collapse
|
4
|
Louie PK, Nemani VM, Leveque JCA. Anterior Cervical Corpectomy and Fusion for Degenerative Cervical Spondylotic Myelopathy: Case Presentation With Surgical Technique Demonstration and Review of Literature. Clin Spine Surg 2022; 35:440-446. [PMID: 36379070 DOI: 10.1097/bsd.0000000000001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
Anterior cervical corpectomy and fusion (ACCF) provides an extensive decompression and provides a large surface area for fusion in patients presenting with cervical spondylotic myelopathy. Unfortunately, this procedure is a more difficult spinal surgery to perform (compared with a traditional anterior cervical discectomy and fusion) and has a higher incidence of overall complications. In literature, ACCF has functional outcomes that seem clinically equivalent to those for multilevel anterior cervical discectomy and fusion, especially when contained to 1 vertebral body level, and in cases, for which both posterior and anterior procedures would be appropriate surgical options, may provide greater long-term clinical benefit than posterior fusion or laminoplasty. In this manuscript, we summarize the indications and outcomes following ACCF for degenerative cervical spondylotic myelopathy. We then describe a case presentation and associated surgical technique with a discussion of complication avoidance with this procedure.
Collapse
Affiliation(s)
- Philip K Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA
| | | | | |
Collapse
|
5
|
Li YS, Tan ECH, Tsai YJ, Mandell MS, Huang SS, Chiang TY, Huang WC, Chang WK, Chu YC. A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial. Front Med (Lausanne) 2022; 9:920726. [PMID: 35847807 PMCID: PMC9276934 DOI: 10.3389/fmed.2022.920726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSurgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.MethodsEighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence of postoperative sore throat and dysphonia.ResultsThe incidence of pressure adjustment after surgical retraction was significantly lower in the tapered group than in the control group (13% vs. 48%; P = 0.001; relative risk reduction, 74%). The median [interquartile range (IQR)] cuff pressure (mm Hg) was significantly lower for the tapered cuff than for the control cuff before surgical retraction [9 (7–12) vs. 12 (10–15); P < 0.001] and after retraction [18 (15–23) vs. 25 (18–31); P = 0.007]. The median (IQR) postoperative dysphonia score assessed by a single speech-language pathologist was lower in the tapered group than in the control group [4 (3–6) vs. 5.5 (5–7); P = 0.008].ConclusionA tapered cuff tracheal tube decreased the need for the adjustment of cuff pressure after surgical retraction during anterior cervical spine surgery, thereby avoiding intraoperative pressure increase. It also has a better outcome in terms of dysphonia.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT04591769].
Collapse
Affiliation(s)
- Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei City, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yueh-Ju Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Mercedes Susan Mandell
- Department of Anesthesiology, University of Colorado, Aurora, CO, United States
- Department of Anesthesiology, McGovern Medical School, Memorial Hermann-Texas Medical Center, University of Texas Health, Houston, TX, United States
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ting-Yun Chiang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Ya-Chun Chu,
| |
Collapse
|
6
|
Risk factors for postoperative dysphagia and dysphonia following anterior cervical spine surgery: a comprehensive study utilizing the hospital for special surgery dysphagia and dysphonia inventory (HSS-DDI). Spine J 2021; 21:1080-1088. [PMID: 33610803 DOI: 10.1016/j.spinee.2021.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative dysphagia and dysphonia (PDD) are prevalent complications after anterior cervical discectomy and fusion (ACDF). Identification of risk factors for these complications is necessary for effective prevention. Recently, patient reported outcome measures (PROM) have been used to determine PDD after ACDF. The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a validated PROM that specifically assesses dysphagia and dysphonia after anterior cervical spine surgery. PURPOSE To identify the perioperative risk factors for PDD utilizing the HSS-DDI. STUDY DESIGN/SETTING Observational study of prospectively collected data at a single academic institution. PATIENT SAMPLE Patients undergoing anterior cervical discectomy and fusion from 2015 to 2019 who enrolled in the prospective data collection. OUTCOME MEASURE The HSS-DDI administered 4 weeks, 8 weeks, and 4-6 months after surgery. METHODS As potential risk factors, the data on demographic factors, analgesic medications, history of psychiatric illness, preoperative sagittal alignment, surgical factors, preoperative diagnoses, and preoperative Neck Disability Index (NDI) scores were collected. Bivariate and multivariable regression analyses utilizing the Tobit model were conducted. RESULTS 291 patients were included in the final analysis. The median HSS-DDI at 4-weeks, 8 weeks, and 4-6 months postoperatively, were 80.7, 92.7, and 98.4, respectively. Multivariable analysis demonstrated that current smoking, previous cervical spine surgery, preoperative C2-7 angle, upper level surgery, multilevel surgery, opioid use, and a high preoperative NDI score, were independent contributing factors to a low HSS-DDI score at 4-weeks follow-up. Intraoperative topical steroid use was an independent protective factor for a low HSS-DDI score. Opioid use and high NDI score remained independent factors at 4-6 months. Sub-domain analysis demonstrated that prior cervical surgery, preoperative C2-7 angle, multilevel surgery, and intraoperative topical steroid use were significant for dysphagia only. Current smoking was significant for dysphonia only. CONCLUSIONS Our results showed that preoperative opioid use and a high preoperative NDI score are novel independent risk factors for postoperative dysphagia and dysphonia in addition to other known factors.
Collapse
|
7
|
Delayed recurrent laryngeal nerve palsy after anterior cervical discectomy and fusion C5-C7: Case report. Neurochirurgie 2021; 68:352-354. [PMID: 34186029 DOI: 10.1016/j.neuchi.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/09/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022]
|
8
|
Gendreau JL, Kim LH, Prins PN, D’Souza M, Rezaii P, Pendharkar AV, Sussman ES, Ho AL, Desai AM. Outcomes After Cervical Disc Arthroplasty Versus Stand-Alone Anterior Cervical Discectomy and Fusion: A Meta-Analysis. Global Spine J 2020; 10:1046-1056. [PMID: 32875831 PMCID: PMC7645085 DOI: 10.1177/2192568219888448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY DESIGN Systemic review and meta-analysis. OBJECTIVES To review and compare surgical outcomes for patients undergoing stand-alone anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for the treatment of cervical spine disease. METHODS A systematic search was performed on PubMed, Medline, and the Cochrane Library. Comparative trials measuring outcomes of patients undergoing CDA and stand-alone ACDF for degenerative spine disease in the last 10 years were selected for inclusion. After data extraction and quality assessment, statistical analysis was performed with R software metafor package. The random-effects model was used if there was heterogeneity between studies; otherwise, the fixed-effects model was used. RESULTS In total, 12 studies including 859 patients were selected for inclusion in the meta-analysis. Patients undergoing stand-alone ACDF had a statistically significant increase in postoperative segmental angles (mean difference 0.85° [95% confidence interval = 0.35° to 1.35°], P = .0008). Patients undergoing CDA had a decreased rate of developing adjacent segmental degeneration (risk ratio = 0.56 [95% confidence interval = -0.06 to 1.18], P = .0745). Neck Disability Index, Japanese Orthopedic Association score, Visual Analogue Scale of the arm and neck, as well as postoperative cervical angles were similar between the 2 treatments. CONCLUSIONS When compared with CDA, stand-alone ACDF offers similar clinical outcomes for patients and leads to increased postoperative segmental angles. We encourage further blinded randomized trials to compare rates of adjacent segmental degeneration and other postoperative outcomes between these 2 treatments options.
Collapse
|
9
|
Alicandri-Ciufelli M, Fermi M, Molinari G, Cavazza Aggazzotti E, Billi AM, Giliberto G, Cavalleri F, Pavesi G, Presutti L. Anatomic and radiologic relationships of neck structures to cervical spine: implications for anterior surgical approaches. ACTA OTORHINOLARYNGOLOGICA ITALICA 2020; 40:248-253. [PMID: 33100335 PMCID: PMC7586192 DOI: 10.14639/0392-100x-n0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/16/2020] [Indexed: 11/24/2022]
Abstract
The position of the pharyngolaryngeal framework is very important in choosing the best surgical approach for cervical spine disease. The aim of the present paper is to investigate the position of the hyoid bone and cricoid cartilage in relation to the cervical spine. Moreover, the surgical implications for anterior transcervical approaches to the upper spine and the prevertebral space are discussed. To minimise complication rates and increase surgical effectiveness, the location and extent of the cervical spine disease should be evaluated in the context of the patient’s specific anatomy. A retrospective analysis of 100 cervical spine MRIs was conducted. Patients with diseases that could alter anatomic relationships of cervical structures were excluded. The mid-sagittal view of the hyoid and the inferior margin of the cricoid cartilage were projected perpendicularly to the anterior surface of the cervical vertebrae. The distance between these two landmarks was measured on the same view. The distribution of hyoid projections ranged between C2-C3 and C4-C5 intervertebral space, while the cricoid cartilage ranged between C4-C5 and C7-T1 intervertebral spaces. The mean distance between these two landmarks was 49.1 ± 7.7 mm, with statistically significant differences between males and females. The position of the cricoid cartilage significantly influenced the length of the pharyngolaryngeal framework, while the position of hyoid did not. A wide range of variability in the position of the hyoid bone and the cricoid cartilage in relation to cervical levels exists. This implies that an a priori association of a cervical level to neck structures at risk might be inaccurate. The use of these easily identifiable landmarks on pre-operative imaging may help to guide the choice among different anterior surgical approaches to cervical spine and reduce the risk of surgical complications.
Collapse
Affiliation(s)
- Matteo Alicandri-Ciufelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy.,Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Matteo Fermi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - Giulia Molinari
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | | | - Anna Maria Billi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giuliano Giliberto
- Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Francesca Cavalleri
- Neuroradiology Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Giacomo Pavesi
- Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara (MO), Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| |
Collapse
|
10
|
Thomas AM, Fahim DK, Gemechu JM. Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck. Diagnostics (Basel) 2020; 10:diagnostics10090670. [PMID: 32899604 PMCID: PMC7555279 DOI: 10.3390/diagnostics10090670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.
Collapse
Affiliation(s)
- Alison M. Thomas
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA; (A.M.T.); (D.K.F.)
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| | - Daniel K. Fahim
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA; (A.M.T.); (D.K.F.)
- Michigan Head & Spine Institute, Southfield, MI 48034, USA
| | - Jickssa M. Gemechu
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
- Correspondence: ; Tel.: +1-248-370-3667
| |
Collapse
|
11
|
Response: Effect of Tracheal Intubation Mode on Cuff Pressure During Retractor Splay and Dysphonia Recovery after Anterior Cervical Spine Surgery. Spine (Phila Pa 1976) 2020; 45:E1052-E1054. [PMID: 32701740 DOI: 10.1097/brs.0000000000003579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
12
|
Huschbeck A, Knoop M, Gahleitner A, Koch S, Schrom T, Stoffel M, Alfieri A, Dengler J. Recurrent Laryngeal Nerve Palsy after Anterior Cervical Discectomy and Fusion - Prevalence and Risk Factors. J Neurol Surg A Cent Eur Neurosurg 2020; 81:508-512. [PMID: 32777828 DOI: 10.1055/s-0040-1710351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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.
Collapse
Affiliation(s)
- Alina Huschbeck
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Michael Knoop
- Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Adrian Gahleitner
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany
| | - Stefan Koch
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Institute of Pathology, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Thomas Schrom
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Otorhinolaryngology, Helios Clinic Bad Saarow, Bad Saarow, Germany
| | - Michael Stoffel
- Department of Neurosurgery, Helios Clinic Krefeld, Krefeld, Germany
| | - Alex Alfieri
- Department of Neurosurgery, Winterthur Cantonal Hospital, Wintherthur, Switzerland.,Faculty 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
- Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.,Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany
| |
Collapse
|
13
|
Rodriguez A, Beltran E, Sanchis‐Mora S, Palacios C. Bilateral laryngeal paralysis following a ventral slot surgery in a dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alfonso Rodriguez
- Anaesthesia and Analgesia DepartmentRoyal Veterinary CollegeLondonUK
| | - Elsa Beltran
- Department of Clinical Science and ServicesRoyal Veterinary College Clinical Services DivisionHatfieldHertfordshireUK
| | - Sandra Sanchis‐Mora
- Anaesthesia and AnalgesiaRoyal Veterinary College Clinical Services DivisionHatfieldHertfordshireUK
| | - Carolina Palacios
- Anaesthesia and AnalgesiaRoyal Veterinary College Clinical Services DivisionHatfieldHertfordshireUK
| |
Collapse
|
14
|
Kamel AAF, Amin OAI, Hassan MAMM, Elmesallamy WAEA, Hassan EM. Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study. J Clin Monit Comput 2020; 35:869-875. [PMID: 32556843 DOI: 10.1007/s10877-020-00546-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
Prediction of vocal cord dysfunction is essential after anterior cervical spine surgeries. This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. Rigid laryngoscopy was the standard confirmatory tool. For postoperative vocal cord edema, the anterior ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 78.9% with PPV = 78.9% and NPV = 88.2% and the novel lateral ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 94.7% with PPV = 93.75% and NPP = 90%. While for paralysis, the anterior ultrasonography approach diagnostic sensitivity = 86.7%, specificity = 85.7% with PPV = 81.25% and NPV = 90% and the novel lateral ultrasonography approach diagnostic (sensitivity, specificity with PPV and NPP) = 100%. The diagnostic accuracy of the novel lateral approach was more correlated to rigid laryngoscopy (91.7% and 100%) compared to anterior approach for vocal cord edema and paralysis (83.3% and 80.6%). Overall incidence of vocal cord paralysis was 16.6%. Risk of vocal cord paralysis was statistically significant more in female, multiple disc herniation, lower and mixed disc levels, Langenbeck retractor, cage and plate and duration of surgery ≥ 1.5 h. Transcutaneous Laryngeal ultrasound is a valid comfortable tool for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries with superiority of the novel lateral over anterior approach.
Collapse
Affiliation(s)
| | | | | | | | - Elham Magdy Hassan
- Phoniatrics at Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt
| |
Collapse
|
15
|
Ian Dhar S, Wegner AM, Rodnoi P, Wuellner JC, Mehdizadeh OB, Shen SC, Nachalon Y, Nativ-Zeltzer N, Belafsky PC, Klineberg EO. Fluoroscopic Swallowing Abnormalities in Dysphagic Patients Following Anterior Cervical Spine Surgery. Ann Otol Rhinol Laryngol 2020; 129:1101-1109. [DOI: 10.1177/0003489420929046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives: To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS). Methods: 129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status. Results: The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls ( P > .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness ( P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 ( P < .0125). Conclusion: Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors. Level of Evidence: 3b
Collapse
Affiliation(s)
- Shumon Ian Dhar
- Johns Hopkins University, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD
| | - Adam M. Wegner
- Washington University in Saint Louis, Department of Orthopedic Surgery, Saint Louis, MO, USA
| | - Pope Rodnoi
- University of California Davis, Department of Orthopaedic Surgery, Sacramento, CA, USA
| | - John C. Wuellner
- University of California Davis, Department of Orthopaedic Surgery, Sacramento, CA, USA
| | - Omid Benjamin Mehdizadeh
- University of California Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA
| | - Shih C. Shen
- University of California Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA
- Chang Gung Memorial Hospital Department of Otolaryngology-Head and Neck Surgery, Linkou
| | - Yuval Nachalon
- University of California Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA
| | - Nogah Nativ-Zeltzer
- University of California Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA
| | - Peter C. Belafsky
- University of California Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA
| | - Eric O. Klineberg
- University of California Davis, Department of Orthopaedic Surgery, Sacramento, CA, USA
| |
Collapse
|
16
|
Effect of Tracheal Intubation Mode on Cuff Pressure During Retractor Splay and Dysphonia Recovery After Anterior Cervical Spine Surgery: A Randomized Clinical Trial. Spine (Phila Pa 1976) 2020; 45:565-572. [PMID: 31770329 DOI: 10.1097/brs.0000000000003339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED MINI: This randomized clinical trial showed different intubation mode in anesthesia did not affect the increase of endotracheal cuff pressure caused by the retractor splay in anterior cervical spine surgery. However, nasotracheal intubation improved postoperative dysphonia recovery after anterior cervical spine surgery. STUDY DESIGN Prospective, randomized, double-blinded trial. OBJECTIVE The aim of this study was to investigate whether the mode of tracheal intubation affects intraoperative endotracheal tube cuff pressure on retractor splay and post-anterior cervical spine surgery (ACSS) voice outcome. SUMMARY OF BACKGROUND DATA The combination of endotracheal tube (ETT) and cervical retractors has been implicated in recurrent laryngeal nerve compression and neuropraxia after ACSS. The asymmetric position of the oroETT within the larynx, as being fixed distally by the cuff and proximally by taping on one side of the mouth, may contribute to unilateral vocal palsy. METHODS Adult patients undergoing ACSS were randomized to receive either nasotracheal or orotracheal intubation under anesthesia. The primary endpoint was the maximal endotracheal tube cuff pressure (ETCP) when the retractors were set up. After the maximal ETCPs were recorded, then ETCPs were controlled to less than 25 mmHg. Secondary endpoints were self-assessed hoarseness, pitch, and loudness of voice on postoperative days (PODs) 1, 2, 7, and 30. RESULTS We equally allocated 110 patients to nasotracheal and orotracheal intubation. The maximal ETCP during retractor splay did not differ for both the means and distributions of pressure range. After the surgery, more patients in the nasotracheal intubation group reported none or mild change of voice than did the orotracheal intubation group on PODs 1 and 2, in terms of hoarseness, pitch, and loudness (P = 0.001, 0.001, and 0.005, respectively, on POD 1; P = 0.002, 0.003, and 0.011, respectively, on POD 2). Mixed model analysis demonstrated that patients with nasotracheal intubation had significantly lower dysphonia scores after surgery (estimate treatment effect: -1.62, P < 0.0001). Statistics was adjusted to exclude interaction with ETT sizes. CONCLUSION The tracheal intubation modes did not affect ETCP during retractor splay. However, nasotracheal intubation had a beneficial effect on dysphonia recovery after ACSS. LEVEL OF EVIDENCE 2.
Collapse
|
17
|
Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:302-322. [PMID: 32309668 DOI: 10.21037/jss.2020.01.14] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
Collapse
Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Revision surgery in cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:47-56. [PMID: 31902001 DOI: 10.1007/s00586-019-06281-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/24/2019] [Accepted: 12/29/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the indications, presurgical planning, operative techniques, complications for making decisions in cervical revision surgery (CRS). METHODS Hundred and two patients underwent CRS over a four-year period. Epidemiological data, the type of first surgery, CRS surgical techniques and complications were retrospectively evaluated. Pain and neurological symptoms were assessed according to the validated Odom criteria. CRS indications were classified into five categories: adjacent segment disease (ASD), infection (INF), implant failure-pseudarthrosis (IFP), non-infectious complication, and deformity. Patients were classified into three groups, according to the approach of the index procedure: anterior, posterior, or 360°. RESULTS The mean patient age was 63 years (59% males). ASD (40%), INF (23%), and IFP (22%) were observed in 85% of patients. CRS was performed with the same approach that was used in the index procedure in 64% of the anterior group and in 83% of the posterior group. In the 360° group, 64% of CRSs was performed with a posterior access. The early complication rate was 4.9%. The outcome was excellent in 19 patients (19%), good in 37 patients (36%), satisfactory in 27 patients (26%), and poor in six patients (6%). Thirteen patients (13%) were lost to follow-up. No implants failed radiologically or required surgical revision. CONCLUSIONS CRS required painstaking planning and mastery of a variety of surgical techniques. The results were rewarding in half and satisfactory in a quarter of the patients. The complication rate was lower than expected. In the most complex cases, referral to a specialized center is recommended. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
19
|
Right- Versus Left-sided Exposures of the Recurrent Laryngeal Nerve and Considerations of Cervical Spinal Surgical Corridor: A Fresh-Cadaveric Surgical Anatomy of RLN Pertinent to Spine. Spine (Phila Pa 1976) 2020; 45:10-17. [PMID: 31415463 DOI: 10.1097/brs.0000000000003204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens which have not previously been reported. OBJECTIVE We aimed to perform surgically relevant exposures of the anterior cervical spine with particular attention to observing the potential vulnerabilities of the RLN on right and left. SUMMARY OF BACKGROUND DATA Vulnerability of the RLN in the anterior cervical spine approach on the right versus left is the subject of ongoing debate. Although most cadaveric studies focus on course variations, structural relations of RLN, they have been done in preserved (fixed) cadavers without relevance to the needs of spinal exposure. METHODS Twelve fresh undyed cadavers had extensive layer by layer dissections by 2 surgeons (one with extensive experience as anatomy dissector). Both sides were explored for vulnerability during cervical spinal procedures. Each dissection was carried out in a phased approach and deliberately explored beyond what can be afforded in live surgery to allow the reader to conceptualize a better view of the structures. RESULTS In all specimens, we consistently demonstrated that the right surgical corridor involved manipulation of the nerve and its branches especially below C5 to achieve optimum midline access: in the right corridor, the RLN is on its oblique course to the tracheoesophageal groove. On the left, RLN is already in the tracheoesophageal groove and out of the surgical field involving minimal direct mobilization of the nerve. CONCLUSION RLN surgical anatomy photographed here is novel in using fresh unprocessed cadaveric specimens which has previously not been reported.Right surgical corridor, below C5, involves retraction/manipulation of RLN for achieving optimum spinal midline access, highlighting potential surgical vulnerability of right RLN. LEVEL OF EVIDENCE 3.
Collapse
|
20
|
Right Versus Left Approach to Anterior Cervical Discectomy and Fusion: An Anatomic Versus Historic Debate. World Neurosurg 2019; 135:135-140. [PMID: 31857270 DOI: 10.1016/j.wneu.2019.12.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
The debate over the influence approach sidedness has on the risk of recurrent laryngeal nerve palsy (RLNP) following anterior cervical discectomy and fusion (ACDF) has its origins with the introduction of the procedure for radicular pain in the 1950s. The recurrent laryngeal nerves follow disparate courses in the lower neck secondary to differences in embryogenesis. Because of these differences, some authors believe a right-sided approach increases the risk of RLNP. However, modern surgical series have not shown a clear risk of RLNP with a right- versus left-sided approach. By looking at the historical context surrounding the introduction of ACDF, we propose the dogmatic view of an increased risk of RLNP with a right-sided approach likely arose from a combination of theoretical anatomic risk and the early surgical experience of a pioneer of the procedure.
Collapse
|
21
|
Horvat D, Lovell J, Boulter J, Sabersky A, Brown J. Case of Vagal Nerve Stimulator-Induced Stridor After Anterior Cervical Diskectomy and Fusion-Induced Vocal Cord Paralysis. World Neurosurg 2019; 134:76-78. [PMID: 31678441 DOI: 10.1016/j.wneu.2019.10.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Vagal nerve stimulation is a generally safe adjunctive treatment for medically refractory epilepsy. Nevertheless, reports of vocal cord dysfunction during stimulation can be found in the literature. When vagal nerve stimulation-induced vocal cord dysfunction is compounded with contralateral dysfunction, such as that which can occur after anterior cervical diskectomy and fusion, serious pulmonary complications can occur. CASE DESCRIPTION A 56-year-old female presented to the emergency department 3 weeks postoperatively from a cervical 7-thoracic 2 anterior cervical diskectomy and fusion through a right-sided approach with new-onset, intermittent stridor. Otorhinolaryngology conducted a fiberoptic laryngoscopy and determined that the patient had a right vocal cord paralysis and intermittent left vocal cord paresis that coincided with activation of the patient's vagal nerve stimulator. The stimulator was shut off, and the patient's stridor disappeared. CONCLUSIONS Vagal nerve stimulation-induced vocal cord paralysis is a rare but known complication. Given this potential for vocal cord dysfunction, neurosurgeons should plan further anterior cervical diskectomy and fusions accordingly to ensure that patients do not develop dysfunction of bilateral vocal cords. Should this develop, however, cessation of vagal nerve stimulation can improve or treat the pulmonologic complication that develops.
Collapse
Affiliation(s)
- David Horvat
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
| | - John Lovell
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason Boulter
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Abraham Sabersky
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joseph Brown
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| |
Collapse
|
22
|
Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis CCW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary. Otolaryngol Head Neck Surg 2019; 158:409-426. [PMID: 29494316 DOI: 10.1177/0194599817751031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.
Collapse
Affiliation(s)
| | | | | | | | - German P Digoy
- 5 Oklahoma State University, Oklahoma City, Oklahoma, USA
| | - Helene J Krouse
- 6 University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | | | | | | | | | - Libby J Smith
- 11 University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- 12 University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- 14 Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C Nnacheta
- 15 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
23
|
Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging. Surg Radiol Anat 2019; 41:943-949. [PMID: 31087139 DOI: 10.1007/s00276-019-02252-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
The right non-recurrent (inferior) laryngeal nerve (NRLN) is a rare anatomical variant associated with an arterial anomaly, the aberrant right subclavian artery (ARSA), that is detectable by pre-operative imaging (POI) using computed tomography and/or ultrasound. Most surgical studies have utilized two major types, NRLNs arising near the upper pole of the thyroid gland (type 1), vs. at a lower level (type 2) but with two subtypes defined by relationships to the inferior thyroid artery (ITA). This review found 8 English language surgical studies using POI that reported at least 1 NRLN and had anatomical information; of the 88 right NRLNs, 69.3% were classified as type 2 and 30.7% as type 1. Meta-analysis yielded a weighted proportion of 74.0% for type 2, but with substantial heterogeneity. For a subgroup of 5 POI studies with information on subtypes, 22 (59.5%) of 37 type 2 nerves were type 2a (i.e., running at or above the ITA). Similarly, a separate review of large surgical series without POI found that 60.4% of all 91 type 2 NRLNs were type 2a. The study findings should be relevant to the increasing numbers of anterior neck surgeries including bilateral thyroidectomies. A need was identified for studies on inter-observer reliability (agreement) among surgeons on NRLN types, and on injury rates (and related symptoms) by the type of NRLN.
Collapse
|
24
|
Kato S, Ganau M, Fehlings MG. Surgical decision-making in degenerative cervical myelopathy – Anterior versus posterior approach. J Clin Neurosci 2018; 58:7-12. [DOI: 10.1016/j.jocn.2018.08.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
|
25
|
Heikkinen M, Halttunen S, Terävä M, Kärkkäinen JM, Löppönen H, Penttilä E. Vocal foldparesis as a surgical complication: Our 10-year experience with 162 incidents. Clin Otolaryngol 2018; 44:179-182. [DOI: 10.1111/coa.13251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Heikkinen
- Department of Otorhinolaryngology; Kuopio University Hospital; Kuopio Finland
- Department of Otorhinolaryngology, Faculty of Health Sciences, Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - Svantte Halttunen
- School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | | | | | - Heikki Löppönen
- Department of Otorhinolaryngology; Kuopio University Hospital; Kuopio Finland
- Department of Otorhinolaryngology, Faculty of Health Sciences, Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - Elina Penttilä
- Department of Otorhinolaryngology; Kuopio University Hospital; Kuopio Finland
- Department of Otorhinolaryngology, Faculty of Health Sciences, Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| |
Collapse
|
26
|
Yerneni K, Burke JF, Nichols N, Tan LA. Delayed Recurrent Laryngeal Nerve Palsy Following Anterior Cervical Discectomy and Fusion. World Neurosurg 2018; 122:380-383. [PMID: 30465958 DOI: 10.1016/j.wneu.2018.11.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vocal cord dysfunction resulting from recurrent laryngeal nerve palsy (RLNP) is a known complication following anterior cervical discectomy and fusion. RLNP occurs typically secondary to neurapraxia caused by intraoperative compression or traction on the nerve and less commonly from direct nerve injury intraoperatively in the setting of anterior cervical spine surgery. Patients with RLNP typically present with hoarseness immediately after surgery owing to unilateral vocal cord paralysis. In rare cases, there is late-onset, progressive development of RLNP that may potentially lead to permanent vocal cord paralysis or respiratory failure. CASE DESCRIPTION A 75-year-old woman presented with myeloradiculopathy and chronic urinary incontinence. Imaging showed severe foraminal and central stenosis with T2 cord signal change. A C4-7 anterior cervical discectomy and fusion was successfully performed without immediate complications following surgery. The patient had a normal voice and was tolerating a regular diet well. On postoperative day 3, the patient developed new hoarseness and dysphagia. An otolaryngologist was consulted, and flexible nasolaryngoscopy showed left vocal cord paralysis consistent with left RLNP. The patient was treated with a course of steroids, and her hoarseness and dysphagia had resolved at the 6-month follow-up visit. CONCLUSIONS To our knowledge, this is the first report of delayed RLNP in patients undergoing anterior cervical discectomy and fusion. This rare complication should be discussed during preoperative patient counseling. Previous literature indicates the underlying pathophysiology for delayed onset of RLNP may be small vessel ischemia, vasospasm, or viral resurgence that leads to recurrent laryngeal nerve dysfunction.
Collapse
Affiliation(s)
- Ketan Yerneni
- Department of Neurological Surgery, UCSF Medical Center, University of California, San Francisco, San Francisco, California, USA
| | - John F Burke
- Department of Neurological Surgery, UCSF Medical Center, University of California, San Francisco, San Francisco, California, USA
| | - Noah Nichols
- Department of Neurological Surgery, UCSF Medical Center, University of California, San Francisco, San Francisco, California, USA
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, University of California, San Francisco, San Francisco, California, USA.
| |
Collapse
|
27
|
Cameron K, Lawless MH, Conway R, Paik G, Tong D, Soo TM, Lopez PP. Risk Factors for Dysphagia Following a Cervical Fusion in a Trauma Population. Cureus 2018; 10:e3489. [PMID: 30613451 PMCID: PMC6314396 DOI: 10.7759/cureus.3489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Dysphagia following a cervical fusion is a known complication; however, this has not been examined in the trauma population. We sought to identify risk factors that can be optimized in this population. Methods We performed a retrospective chart review on consecutive trauma patients who underwent a cervical fusion from 2014 to 2017 at a single institution with multiple surgeons. We included patients more than 18-years-old who were admitted through the emergency department with a diagnosis of acute cervical injury and underwent a cervical fusion during the same admission. We excluded patients who remained intubated postoperatively or underwent a tracheostomy. The primary outcome was dysphagia as evaluated by a bedside swallow test on postoperative day one by the nursing staff. This was followed by a standardized assessment performed by a speech therapist on postoperative day two in some cases. Variables of interest included sex, age, mechanism of injury, surgical approach, cervical levels, and Charlson comorbidity index. Univariate analysis was also utilized. Results Sixty patients met the study criteria. Nineteen patients (31.7%) developed dysphagia postoperatively. Mechanical falls were the most common injury mechanism (80%) and most surgical procedures were performed on the subaxial cervical spine (68.3%). Comparing the dysphagia groups, there was no significant difference among the confounding variables. Patients with dysphagia had an increased length of stay (10.6 ± 6.7 vs. 7.4 ± 3.1, p = 0.056) and were more likely to have had an anterior vs. posterior cervical fusion (63.2% vs. 34.1%, p = 0.056). Conclusions We found no statistically significant risk factors leading to postoperative dysphagia. The objective of this pilot is to find the baseline dysphagia rate and the potential modifiable factors in this unique patient population undergoing cervical fusion procedures.
Collapse
Affiliation(s)
- Kathryn Cameron
- Surgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Michael H Lawless
- Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Robert Conway
- Surgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Gijong Paik
- Research, Michigan Spine and Brain Surgeons, Southfield, USA
| | - Doris Tong
- Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Teck M Soo
- Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| | - Peter P Lopez
- Surgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA
| |
Collapse
|
28
|
Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis C(CW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg 2018; 158:S1-S42. [DOI: 10.1177/0194599817751030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Libby J. Smith
- University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
29
|
Yu S, Chen Z, Yan N, Hou T, He S. Incidence and Factors Predictive of Dysphagia and Dysphonia After Anterior Operation With Multilevel Cervical Spondylotic Myelopathy. Clin Spine Surg 2017; 30:E1274-E1278. [PMID: 28402988 DOI: 10.1097/bsd.0000000000000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective database analysis. OBJECTIVE OF THE STUDY The objective of the study was to quantify the incidence of dysphagia and dysphonia and assess the associated risk factors after multilevel cervical anterior operation. SUMMARY OF BACKGROUND DATA Anterior approach for multilevel cervical spondylotic myelopathy has been developed and obtained favorable outcomes. As number of fused levels increased, the operation difficulty, invasiveness and operative risks are higher. Meanwhile, the 2 most common postoperative complications described in the literature are dysphonia and dysphagia. MATERIALS AND METHODS Two hundred thirty-six multilevel cervical spondylotic myelopathy patients between October 2004 and June 2012 were included in the study. All patients undergoing anterior operation, and incidences of dysphagia were identified. Risk factors were assessed using logistic regression. RESULTS At a minimum of 1 year after operation, 70.6% (n=156) were 3-level anterior operation and 29.4% (n=65) were 4-level anterior operation. The overall dysphagia rate was 23.1% (51 patients). The overall dysphonia rate was 28.5% (63 patients). Logistic regression analysis demonstrated that risk factors for dysphagia included age, operation time and lack of tracheal traction exercise. Age, operation time were 2 factors significantly related to dysphonia. CONCLUSIONS The incidence of postoperative dysphagia and dysphonia is relative higher after multilevel anterior operation. Age and operation time carry a greater risk of postoperative dysphagia and dysphonia. Tracheal traction exercise might help patients reduce postoperative dysphagia. Sufficient preoperative preparation and evaluation combining with proficient and precise operation technique are suggested when multilevel anterior fusion is performed.
Collapse
Affiliation(s)
- Shunzhi Yu
- *Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine †Department of Orthopedics, Renji Hospital, Shanghai, China
| | | | | | | | | |
Collapse
|
30
|
Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation. Acta Neurochir (Wien) 2017; 159:1283-1287. [PMID: 28451842 PMCID: PMC5486609 DOI: 10.1007/s00701-017-3189-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/11/2017] [Indexed: 11/02/2022]
Abstract
BACKGROUND Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve symptoms. During the last decades, multiple fusion techniques have been developed, although without clinical evidence for added value of fusion over non-fusion. METHODS The surgical procedure of anterior cervical discectomy without fusion is performed step by step, leading to removal of the entire intervertebral disk. CONCLUSION Anterior cervical discectomy without fusion is a safe and effective treatment for cervical disk herniation.
Collapse
|
31
|
Cacciola F, Lippa L. Complications in the anterior approach to the cervical spine: Which factors matter? Int J Surg 2017; 45:160-161. [PMID: 28435026 DOI: 10.1016/j.ijsu.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Cacciola
- Department of Neurosurgery, Università degli Studi di Siena, Policlinico "Santa Maria alle Scotte", 53100, Siena, Italy.
| | - Laura Lippa
- Department of Neurosurgery, Università degli Studi di Siena, Policlinico "Santa Maria alle Scotte", 53100, Siena, Italy
| |
Collapse
|
32
|
Anatomic Relationship Between Right Recurrent Laryngeal Nerve and Cervical Fascia and Its Application Significance in Anterior Cervical Spine Surgical Approach. Spine (Phila Pa 1976) 2017; 42:E443-E447. [PMID: 28399552 DOI: 10.1097/brs.0000000000001881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An anatomic study of anterior cervical dissection of 42 embalmed cadavers. OBJECTIVE The aim was to study the anatomic relationship between recurrent laryngeal nerve (RLN) and cervical fascia combined with the requirements in anterior cervical spine surgery (ACSS). SUMMARY OF BACKGROUND DATA There has been no systematic research about how to avoid RLN injury in anterior cervical spine surgical approach from the aspect of the anatomic relationship between RLN and cervical fascia. METHODS Forty-two adult cadavers were dissected to observe the relationships between RLN and different cervical fascia layers. RESULTS RLN pierced out the alar fascia from the inner edge of the carotid sheath in all cases, and the piercing position in 22 cases (52.4%) was located at the lower segment of T1. The enter point into visceral fascia of RLN was located at C7-T1 in 25 cases (59.5%). The middle layer of deep cervical fascia exhibited the most stable anatomic relationship with RLN at the carotid sheath confluence site. Pulling visceral sheath leftwards would significantly increase the RLN tension. CONCLUSION Using the close and stable relationship between RLN and cervical fascia could help to avoid RLN injury in anterior cervical spine surgical approach. LEVEL OF EVIDENCE 4.
Collapse
|
33
|
Impact of smoking on postoperative complications after anterior cervical discectomy and fusion. J Clin Neurosci 2017; 38:106-110. [DOI: 10.1016/j.jocn.2016.12.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022]
|
34
|
Gokaslan ZL, Bydon M, De la Garza-Ramos R, Smith ZA, Hsu WK, Qureshi SA, Cho SK, Baird EO, Mroz TE, Fehlings M, Arnold PM, Riew KD. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study. Global Spine J 2017; 7:53S-57S. [PMID: 28451492 PMCID: PMC5400187 DOI: 10.1177/2192568216687547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Multicenter retrospective study. OBJECTIVES To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. METHODS A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patients were included if they underwent cervical spine surgery (levels from C2 to C7) between January 1, 2005 and December 31, 2011. Data were analyzed with regard to complication treatment and outcome. Cases were compared to a control group from the AOSpine CSM and CSM-I studies. RESULTS Three centers reported 19 cases of RLNP from a cohort of 1345 patients. The reported incidence of RLNP ranged from 0.6% to 2.9% between these 3 centers. Fifteen patients (79%) in the RLNP group were approached from the left side. Ten patients (52.6%) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). When examining outcomes, 73.7% (14/19) of cases resolved completely, 15.8% (3/19) resolved with residual effects, and in 10.5% (2/19) of cases this could not be determined. CONCLUSIONS In this multicenter study examining rare complications following cervical spine surgery, the risk of RLNP after cervical spine surgery ranged from 0.6% to 2.9% between centers. Though rare, it was found that 16% of patients may experience partial resolution with residual effects, and 74% resolve completely.
Collapse
Affiliation(s)
- Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA,The Miriam Hospital, Providence, RI, USA,Norman Prince Neurosciences Institute, Providence, RI, USA,Ziya L. Gokaslan, Norman Prince Neurosciences Institute, Rhode Island Hospital, 593 Eddy Street, APC-6, Providence, RI 02903, USA.
| | | | | | - Zachary A. Smith
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wellington K. Hsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan O. Baird
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - K. Daniel Riew
- Columbia University, New York, NY, USA,The Spine Hospital at NY-Presbyterian/Allen, New York, NY, USA
| |
Collapse
|
35
|
Rajabian A, Walsh M, Quraishi NA. Berry's Ligament and the Inferior Thyroid Artery as reliable anatomical landmarks for the Recurrent Laryngeal Nerve (RLN): a fresh-cadaveric study of the cervical spine. The RLN relevant to spine. Spine J 2017; 17:S33-S39. [PMID: 28108406 DOI: 10.1016/j.spinee.2017.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/25/2016] [Accepted: 01/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although most cadaveric studies of the Recurrent Laryngeal Nerve (RLN) have focused on course variations, they have usually been done on preserved (fixed and embalmed) cadavers, which renders the RLN immobile and of less surgical landmark value. PURPOSE Our aim was to perform a thorough exposure in fresh cadavers, with the intention of investigating the Inferior Thyroid Artery (ITA) and Berry's ligament as reliable landmarks for the identification of the RLN in anterior cervical spine surgery. STUDY DESIGN/SETTING Eight fresh cadavers had layer by layer dissections by two surgeons (one with extensive experience as anatomy dissector) from C2 to T2-T3, with particular attention to illustrating the surgical anatomy of the RLN pertinent to spine. METHODS We exposed, traced, and referenced the position of RLNs along their entire length bilaterally and examined the reliability of using ITA and superficial fascia of Berry's Ligament as landmark. RESULTS In all specimens, we were able to verify the entire course of RLNs on both the right and left sides in all cadavers dissected in detail from origin to insertion. The RLNs were consistently associated with the ITA and Berry's ligament bilaterally, with the RLNs passing almost perpendicular to these structures. CONCLUSIONS We found that the most reliable anatomical landmark for the RLN bilaterally was the ITA and Berry's ligament, both of which would be encountered as readily identifiable structures in anterior cervical spinal exposure before the nerve itself. We believe this will help spinal surgeons to refine their surgical technique to identify RLN where necessary, thus preventing iatrogenic injury. Our landmark protocol of FEEL-LOOK-AVOID can serve as an easy aide-mémoire for intraoperative surgical anatomy of the RLN during ACDF regardless of side.
Collapse
Affiliation(s)
- Ali Rajabian
- Nottingham Centre for Spinal Studies and Surgery, Queens Medical Centre, Derby Rd, Nottingham, NG7 2UH, UK.
| | - Michael Walsh
- Nottingham Centre for Spinal Studies and Surgery, Queens Medical Centre, Derby Rd, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- Nottingham Centre for Spinal Studies and Surgery, Queens Medical Centre, Derby Rd, Nottingham, NG7 2UH, UK
| |
Collapse
|
36
|
Tewari A, Samy RN, Castle J, Frye TM, Habeych ME, Mohamed M. Intraoperative Neurophysiological Monitoring of the Laryngeal Nerves During Anterior Neck Surgery: A Review. Ann Otol Rhinol Laryngol 2016; 126:67-72. [PMID: 27803238 DOI: 10.1177/0003489416675354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery.
Collapse
Affiliation(s)
- Anurag Tewari
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Ravi N Samy
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | - Miguel E Habeych
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Mahmoud Mohamed
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Ohio, USA
| |
Collapse
|
37
|
Rao RR, Ha J, Farley FA, Koopmann CF, Caird MS. Vocal Cord Paresis After Posterior Spinal Fusion to Treat Adolescent Idiopathic Scoliosis: A Case Report. JBJS Case Connect 2016; 6:e97. [PMID: 29252751 DOI: 10.2106/jbjs.cc.16.00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 15-year-old girl with adolescent idiopathic scoliosis with a 50° curve underwent posterior spinal fusion from T3 to T11. After discharge from the hospital, the patient reported dysphonia and dysphagia. Flexible nasendoscopy confirmed left vocal cord paresis. Stretch injury to the recurrent laryngeal nerve from the left T5 pedicle screw or intubation may have caused the vocal cord paresis. The pedicle screw was removed during revision surgery. Postsurgically, the patient demonstrated immediate and ultimately full recovery and no longer had any symptoms. CONCLUSION To our knowledge, this is the first case report of vocal cord paresis most likely caused by pedicle screw position after posterior spinal fusion.
Collapse
Affiliation(s)
| | - Jennifer Ha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Frances A Farley
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Charles F Koopmann
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
38
|
Abstract
Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.
Collapse
Affiliation(s)
- So Kato
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T2S8, Canada.
| |
Collapse
|
39
|
Causes and imaging manifestations of paralysis of the recurrent laryngeal nerve. RADIOLOGIA 2016; 58:225-34. [PMID: 27066920 DOI: 10.1016/j.rx.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/21/2022]
Abstract
The vocal cords play a key role in the functions of the larynx. Their motor innervation depends on the recurrent laryngeal nerve (a branch of the tenth cranial nerve), which follows a long trajectory comprising intracranial, cervical, and mediastinal segments. Vocal cord paralysis usually manifests as dysphonia, the main symptom calling for CT study, the first-line imaging test to investigate the cause of the lesion. Patients are asymptomatic in a third of cases, so the incidental detection of signs of vocal cord paralysis in a CT study done for other reasons should prompt a search for a potentially severe occult lesion. This article aims to familiarize readers with the anatomy of the motor innervation of the glottis, the radiological presentation and most common causes of vocal cord paralysis, and conditions that can simulate vocal cord paralysis.
Collapse
|
40
|
Swann MC, Hoes KS, Aoun SG, McDonagh DL. Postoperative complications of spine surgery. Best Pract Res Clin Anaesthesiol 2016; 30:103-20. [PMID: 27036607 DOI: 10.1016/j.bpa.2016.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated [1-4]. Here we review a range of complications in the early postoperative period from more benign complications such as postoperative nausea and vomiting (PONV) to more feared complications leading to permanent loss of neurological function or death [5]. Perioperative pain management is covered in a separate review (Chapter 8).
Collapse
Affiliation(s)
- Matthew C Swann
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kathryn S Hoes
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - David L McDonagh
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| |
Collapse
|