Dysphonia and dysphagia after anterior cervical decompression

Abstract

<jats:sec> <jats:title>Object.</jats:title> <jats:p>In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function.</jats:p></jats:sec> <jats:sec> <jats:title>Methods.</jats:title> <jats:p>The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology—Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography.</jats:p></jats:sec> <jats:sec> <jats:title>Results.</jats:title> <jats:p>Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions.</jats:title> <jats:p>Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.</jats:p></jats:sec>

Dysphagia following combined anterior-posterior cervical spine surgeries

“…2,5,6,9,10,12,16,18,21,22,[27][28][29]31,32 However, the associations are not consistent among studies.…”

“…Fortunately, most studies show dysphagia to be typically a transient phenomenon following anterior cervical surgery. 2,22,31 The pathophysiology of dysphagia following cervical spine surgery remains poorly understood. Several factors have been suggested to be related to the development of postsurgical dysphagia, including patient age, female sex, obesity, length of surgery, specific spinal level(s) of surgery, multilevel surgery, use of instrumen- Object.…”

What Is the Incidence and Severity of Dysphagia After Anterior Cervical Surgery?

“…Other studies suggest, however, that these interventions have no effect on postoperative dysphagia [3,23]. Various intraoperative and patient factors (ie, age, gender, body mass index, operative time, estimated blood loss, number of levels of surgery, location of surgery, and plate thickness) have been investigated as potential risk factors for postoperative dysphagia with inconsistent findings [4,7,17,18,23,27,29]. Fortunately, postoperative dysphagia is typically a transient phenomenon.…”

“…Generally speaking, these procedures provide return to function and pain relief and a low incidence of major complications [1,10,14,19,21,22,25,26]. The most common patient complaint after this procedure is dysphagia; the reported incidence of which is up to 69% in the early postoperative period [12,29,30]. The proposed causes of postoperative dysphagia include recurrent laryngeal nerve palsy, esophageal ischemia and reperfusion injury, and local soft tissue swelling.…”

Speech-language pathology treatment time during inpatient spinal cord injury rehabilitation: the SCIRehab project

“…27 This may be due to damage or insult to the vagus nerve (the recurrent laryngeal nerve) and/or distension or soft tissue swelling, which can be associated with the surgery. Tervonen et al 28 reported that 69% of patients with anterior cervical surgeries had dysphagia immediately post-operatively (within the first week); however, after 3 months, most dysphagia had resolved. Several issues may contribute to SLPs spending more time evaluating and treating swallowing deficits than cognitive-communication problems.…”