Recurrent Laryngeal Nerve Palsy after Anterior Cervical Spine Surgery

Audu, Paul; Artz, Greg; Scheid, Sarah; Harrop, James S.; Albert, Todd J.; Vaccaro, Alexander R.; Hilibrand, Alan S.; Sharan, Ashwini; Spiegal, Joseph; Rosen, M.

doi:10.1097/00000542-200611000-00009

Cited by 57 publications

(10 citation statements)

References 12 publications

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“…[9] These complications occur as a result of direct surgical trauma, nerve division, pressure or stretch induced neuropraxia, and ETT-related vocal fold palsy. [310] Audu and colleagues[11] reported 3.2% incidence of vocal cord palsy after ACDF which is comparable to the results of our study (2.7%).…”

Section: Discussionsupporting

confidence: 90%

Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

et al. 2010

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Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values) and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7%) and two patients had postoperative hoarseness of voice (5.4%). All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve ‘just seal’, with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

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Section: Discussionsupporting

confidence: 90%

Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

et al. 2010

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“…With regards to anterior cervical spine surgery, lowering the ETT cuff pressure after placement of the retractor may influence postoperative dysphagia, sore throat, and hoarseness. However, a randomized controlled trial showed that pressure adjustment did not reduce the incidence of vocal cord immobility [11]. A small study from 2002 analysed patients undergoing anterior cervical spine surgery and data suggested a lower incidence of sore throat in patients with lower cuff pressures, while a recently performed observational study showed less recurrent laryngeal nerve palsy in patients with reduction of ETT cuff pressure [5,12].…”

Section: Introductionmentioning

confidence: 99%

Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

Arts

Rettig

Vries

et al. 2013

BMC Musculoskelet Disord

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BackgroundIn anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia.Methods/design177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months.DiscussionPostoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial.Trial registrationNetherlands Trial Register (NTR) 3542: http://www.trialregister.nl.

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“…[14][15][16] The most likely mechanisms of RLN injury include indirect stretch or focal pressure on the nerve, 2 and the former was accepted by more researchers. 17,18 Based on this theory, ACCF is a more probable cause of hoarseness as ACCF needs more space and the retractor stretches more compared with ACDF. As a result, arytenoid dislocation is tend to be misdiagnosed when hoarseness occures after ACCF.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Hoarseness Caused by Arytenoid Dislocation After Anterior Cervical Corpectomy and Fusion

Zhong

et al. 2016

SPINE

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Recurrent Laryngeal Nerve Palsy after Anterior Cervical Spine Surgery

Abstract: Endotracheal tube cuff deflation/reinflation and pressure adjustment do not reduce the incidence of vocal fold immobility in anterior cervical spine surgery.

Cited by 57 publications

References 12 publications

Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

Prolonged Hoarseness Caused by Arytenoid Dislocation After Anterior Cervical Corpectomy and Fusion

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