Incidence of Asymptomatic Recurrent Laryngeal Nerve Palsy Following Anterior Cervical Spine Surgery

Abstract

Objective: Anterior cervical spine surgery (ACSS) has become the most preferred surgical approach for the subaxial cervical spine. To understand the laryngeal complications, the recurrent laryngeal nerve (RLN) is the most important anatomical landmark. Because RLN palsy are often subclinical, there are few data on the incidence of total RLN palsy, and for this reason, asymptomatic RLN injuries are thought to be even more common. In this prospective study, we aimed to determine the incidence of asymptomatic RLN palsy after ACSS. Materials and Methods: A total of 46 patients who underwent ACSS between November 4, 2019 and June 30, 2021 during the corona disease pandemic, were enrolled in this single-centre, prospective study. Only anteromedial approaches were evaluated. Preoperative video laryngoscopic intubation was performed before ACSS to assess the vocal cords. Indirect laryngoscopy was performed to assess postoperative status. Results: ACSS was performed at one level in 36 patients and at two levels in 10 patients. The average duration of the procedure was 128.13 minutes and the average retraction time was 69.19 minutes. Dysphonia after ACSS was observed in 3 patients (6.52%), whereas asymptomatic RLN palsy was noted in only 2 patients (4.34%). These patients showed only unilateral vocal cord paralysis on indirect laryngoscopy, which was consistent with RLN injury.