On the Incidence, Cause, and Prevention of Recurrent Laryngeal Nerve Palsies During Anterior Cervical Spine Surgery

Apfelbaum, Ronald I.; Kriskovich, Mark D.; Haller, Jeffrey R.

doi:10.1097/00007632-200011150-00012

Cited by 270 publications

(140 citation statements)

References 19 publications

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“…For this reason, it is essential that odontoid fixation screws engage the cortex fully; to do so, a shallow trajectory from the low cervical area is necessary. The guide tube instrumentation we have developed 7,8 facilitates performing this accurately, but the patient's anatomy must allow this trajectory. Subaxial cervical spondylosis may result in a rigid neck in a straight or even kyphotic angulation that are contraindicative for this trajectory, and a large chest and short neck, alone or in combination with the above, may also limit access.…”

Section: Discussionmentioning

confidence: 99%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

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112

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Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

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Section: Discussionmentioning

confidence: 99%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

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112

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“…After the longus colli is dissected laterally and the retractors are placed, the endotracheal cuff is deflated and reinflated to diminish recurrent laryngeal nerve compression from restraction. 1 The midline of the VBs are marked, and the overhanging lip of the superior VB is carefully drilled away to open up the disc space. The intervertebral disc and cartilaginous endplates are thoroughly removed.…”

Section: Surgical Techniquementioning

confidence: 99%

Multilevel cervical arthroplasty with artificial disc replacement

Cardoso¹,

Rosner²

2010

FOC

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Object In this study, the authors review the technique for inserting the Prestige ST in a contiguous multilevel cervical disc arthroplasty in patients with radiculopathy and myelopathy. They describe the preoperative planning, surgical technique, and their experience with 10 patients receiving a contiguous Prestige ST implant. They present contiguous multilevel cervical arthroplasty as an alternative to multilevel arthrodesis. Methods After institutional board review approval was obtained, the authors performed a retrospective review of all contiguous multilevel cervical disc arthroplasties with the Prestige ST artificial disc between August 2007 and November 2009 at a single institution by a single surgeon. Clinical criteria included patients who had undergone a multilevel cervical disc arthroplasty performed for radiculopathy and myelopathy without the presence of a previous cervical fusion. Between August 2007 and November 2009, 119 patients underwent cervical arthroplasty. Of the 119 patients, 31 received a Hybrid construct (total disc resection [TDR]–anterior cervical decompression and fusion [ACDF] or TDR-ACDF-TDR) and 24 received a multilevel cervical arthroplasty. The multilevel cervical arthroplasty group consisted of 14 noncontiguous and 10 contiguous implants. This paper examines patients who received contiguous Prestige ST implants. Results Ten men with an average age of 45 years (range 25–61 years) were treated. Five patients presented with myelopathy, 3 presented with radiculopathy, and 2 presented with myeloradiculopathy. Twenty-two 6 × 16–mm Prestige ST TDRs were implanted. Six patients received 2-level Prestige ST implants. Five patients received TDRs at C5–6 and C6–7, and 1 patient received TDRs at C3–4 and C4–5. One patient received a TDR at C3–4, C5–6, and C6–7 where C4–5 was a congenital block vertebra. Three patients (2 with 3-level disease and 1 with 4-level disease) received contiguous Prestige ST implants as well as a Prevail ACDF as part of their constructs. The mean clinical and radiographic follow-up was 12 months. There has been no case of screw backout, implant dislodgment, progressive kyphosis, formation of heterotopic bone, evidence of pseudarthrosis at the Prevail levels, or development of symptomatic adjacent level disease. Conclusions Multilevel cervical arthroplasty with the Prestige ST is a safe and effective alternative to fusion for the management of cervical radiculopathy and myelopathy.

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“…Dysphagia and Dysphonia are known complications after anterior cervical spine procedures Dysphagia could be secondary to the injury of superior 25 , recurrent laryngeal nerve 26 , hypoglossal 27 and glossopharyngeal nerve 25 . The incidence of this complication varies from 2 to 50 % depending on the type of study and evaluation methodology 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

Muralidharan

Loke

Habeych

et al. 2016

Journal of Clinical Neuroscience

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Abstract:Objective: The primary aim of this study is to conduct a systematic review of reports concerning patients with cervical spondylotic myelopathy to assess the value of intraoperative monitoring (IOM), such as SSEPs, TcMEPs, and EMG, in anterior cervical procedures. Methods: A search strategy was first conducted in order to collect a small database of relevant papers using key words describing both disorders and procedures of interest. The database was then shortlisted using selection criteria and data from these finalized reports was extracted to identify complications as a result of anterior cervical procedures treating cervical spondylotic myelopathy for outcome analysis on a continuous scale. Results: In the 22 studies that matched the screening criteria, only two involved the use of IOM. The 22 studies had an average of 173 patients. In studies with procedures done without IOM a mean change in JOA score of 3.94 points and a mean change in Nurick score by 1.20 points (both less severe post-op) were observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia had a mean outcome of 2.71% of cases for studies without IOM and a mean outcome of 0.91% of cases for studies with IOM. Conclusions: Based on the review of published studies sufficient evidence does not exist to negate or reinforce the use of IOM in hopes of reducing neurological complications during anterior cervical procedures. There is no standardized evaluation method to measure these complications. In addition, the modalities used for IOM have not been overwhelmingly confirmed.

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On the Incidence, Cause, and Prevention of Recurrent Laryngeal Nerve Palsies During Anterior Cervical Spine Surgery

Abstract: The most common cause of vocal cord paralysis after anterior cervical spine surgery is compression of the RLN within the endolarynx. Monitoring of ET cuff pressure and release after retractor placement may prevent injury to the RLN during anterior cervical spine surgery.

Cited by 270 publications

References 19 publications

Anterior fixation of odontoid fractures in an elderly population

Anterior fixation of odontoid fractures in an elderly population

Multilevel cervical arthroplasty with artificial disc replacement

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

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