see also: Vocal Cord Paralysis Evaluation and Etiology; Unilateral Laryngeal Paralysis or Vocal Cord Paralysis
The laryngeal-pharyngeal functions of swallowing and voicing may be altered in the course of an anterior cervical fusion termed 'ACF' (Jacobson 2014). These investigators identified that the anterior approach for cervical spine surgery - first developed in the 1950's - has become one of the most commonly performed spinal procedures with more than 500,000 performed in the United States between 1990 and 1999 - with over 200,000 performed each year beginning in 2002. Most who have the ACF procedure have a good clinical outcome with adverse events thought to be infrequent and - when present - manageable. However, dysphagia, odynophagia and hoarseness have been reported with an incidence that is difficult to determine.
Erwood et al. (2018) identified variable rates of vocal cord paralysis (as high as 22%) and dysphagia (as high as 71%). A two-team approach (Neurosurgery and Otolaryngology) prospectively evaluated 67 patients who were treated with re-operative ACDF (anterior cervical diskectomy and fusion) at the University of Alabama and identified only 5 patients (7.5%) with new postoperative temporary VCP after reoperative ACDF with all resolved by 2 months postoperatively. 25 patients had a new swallowing disturbance detected on FEES (fiberoptic endoscopic evaluation of swallowing) 2 weeks following the ACDF- with most being mild and not requiring intervention. These investigators support a two-team approach with Otolaryngology providing the access with the comment offered: "An explanation for how the head and neck surgeon may be able to provide safer access to the cervical spine, despite having never performed an ACDF procedure, probably relates to cross training achieved through other surgeries that otolaryngologists perform in the anterior neck."
Jacobson et al. (2014) reviewed the radiographic evaluation of dysphagia in 74 out of 1,789 ACF and identified dysphagia to be more common after mid cervical spine surgery. 91% (N=67) of those studied radiographically were identified with soft-tissue swelling with displacement of the pharynx of esophagus. These investigators and others have identified that the importance of postoperative dysphagia is underestimated by spinal surgeons (Rihn 2011).
References
Erwood MS, Walters BC, Connolly TM, Gordon AS, Carroll WR, Agee BS, Carn BR, Hadley MN.Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach. Neurosurg Spine. 2018 Feb;28(2):140-148. doi: 10.3171/2017.5.SPINE161104. Epub 2017 Nov 24.
Kriskovich MD, Apfelbaum RI, Haller JR. Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury. Laryngoscope. 2000 Sep;110(9):1467-73.
Laura R. Carucci1 Mary Ann Turner1 C. Fitzhugh Yeatman2Dysphagia Secondary to Anterior Cervical Fusion: Radiologic Evaluation and Findings in 74 Patients AJR 2015; 204:768–775
Jacobson L. Bilateral vocal cord paralysis. Bilateral vocal cord paralysis following anterior cervical fusion.Jacobson L - Anaesthesia - November 1, 1979; 34 (10); 1020-3
Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res 2011; 469:658–665
Edwards CC 2nd, Karpitskaya Y, Cha C, et al. Accurate identification of adverse outcomes after cervical spine surgery. J Bone Joint Surg Am 2004; 86:251–256