PMID- 34670988
OWN - NLM
STAT- MEDLINE
DCOM- 20220329
LR  - 20230831
IS  - 2380-0194 (Electronic)
IS  - 2380-0186 (Linking)
VI  - 35
IP  - 2
DP  - 2022 Mar 1
TI  - Laryngoscopic Screening Before Revision Anterior Cervical Spine Surgery: Is Vocal 
      Cord Palsy a Relevant Factor in Deciding the Approach Direction?
PG  - E292-E297
LID - 10.1097/BSD.0000000000001253 [doi]
AB  - STUDY DESIGN: Retrospective study. OBJECTIVES: The aim was to evaluate the exact 
      incidence of vocal cord palsy (VCP) caused by previous anterior cervical spine 
      surgery (ACSS) and aid surgeons in deciding the approach direction in revision 
      ACSS. SUMMARY OF BACKGROUND DATA: The incidence of VCP detected by preoperative 
      laryngoscopic screening before revision ACSS appeared to be much higher in 
      previous reports than in our experience. MATERIALS AND METHODS: We reviewed the 
      data of 64 patients who underwent revision ACSS. Preoperative laryngoscopy was 
      performed in all patients to detect VCP and/or structural abnormalities of the 
      vocal cords. The patients' characteristics, laryngoscopy results, and symptoms 
      before revision surgery that were potentially caused by previous recurrent 
      laryngeal nerve injuries (voice change, foreign body sensation, and chronic 
      aspiration) were recorded. RESULTS: Laryngoscopy demonstrated no complete VCP or 
      decreased vocal cord motility. Eleven patients (17.2%) showed vocal cord-related 
      symptoms and 13 patients (20.3%) showed abnormal laryngoscopic findings without 
      VCP. Four patients (6.2%) showed vocal cord-related symptoms and abnormal 
      laryngoscopic findings simultaneously. At the initial operative level, no 
      significant differences in vocal cord-related symptoms were observed between the 
      upper and lower levels (C3-4-5 vs. C5-6-7). However, the frequency of vocal 
      cord-related symptoms was significantly high at the larger number of levels (>/=3 
      segments) (P=0.010). CONCLUSIONS: In contrast to previous reports, this study 
      demonstrated that VCP is rarely detected before revision ACSS. Therefore, 
      deciding the approach direction with only vocal cord motility can be dangerous, 
      and more attention is required in setting the approach direction in patients who 
      show both vocal cord-related symptoms and abnormal laryngoscopic finding. In 
      other cases, a contralateral approach which has a low risk of bilateral VCP could 
      be utilized if necessary.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Seok, Sang Yun
AU  - Seok SY
AD  - Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University 
      School of Medicine, Daejeon.
FAU - Lee, Dong-Ho
AU  - Lee DH
AD  - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul.
FAU - Park, Se Han
AU  - Park SH
AD  - Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi.
FAU - Lee, Hyung Rae
AU  - Lee HR
AD  - Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji 
      University School of Medicine, Uijeongbu, Gyeonggido, Korea.
FAU - Cho, Jae Hwan
AU  - Cho JH
AD  - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul.
FAU - Hwang, Chang Ju
AU  - Hwang CJ
AD  - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul.
FAU - Lee, Choon Sung
AU  - Lee CS
AD  - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Spine Surg
JT  - Clinical spine surgery
JID - 101675083
SB  - IM
MH  - Cervical Vertebrae/surgery
MH  - Humans
MH  - Laryngoscopy/adverse effects
MH  - Reoperation/adverse effects
MH  - Retrospective Studies
MH  - *Vocal Cord Paralysis/diagnosis/epidemiology/etiology
COIS- The authors declare no conflict of interest.
EDAT- 2021/10/22 06:00
MHDA- 2022/03/30 06:00
CRDT- 2021/10/21 05:45
PHST- 2021/04/05 00:00 [received]
PHST- 2021/09/15 00:00 [accepted]
PHST- 2021/10/22 06:00 [pubmed]
PHST- 2022/03/30 06:00 [medline]
PHST- 2021/10/21 05:45 [entrez]
AID - 01933606-202203000-00007 [pii]
AID - 10.1097/BSD.0000000000001253 [doi]
PST - ppublish
SO  - Clin Spine Surg. 2022 Mar 1;35(2):E292-E297. doi: 10.1097/BSD.0000000000001253.