Kilburg Craig, Sullivan Humbert G, Mathiason Michelle A
Department of Neurosurgery, Gundersen Lutheran Medical Center, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin 54601, USA.
J Neurosurg Spine. 2006 Apr;4(4):273-7. doi: 10.3171/spi.2006.4.4.273.
This retrospective study was designed to determine whether side of approach during instrumented, one- or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC).
Records of all patients who underwent one- or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed. Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of RLN injury diagnosed by OVC after referral for persistent dysphonia. Time from surgery to OVC for patients with right-sided exposures was not statistically different from that for patients with left-sided exposures. Of 418 patients, 278 (66.5%) had right-sided exposures and 140 (33.5%) had left-sided exposures. Eight RLN injuries (1.9%) were noted-five in patients with right-sided exposures (1.8%) and three in patients with left-sided exposures (2.1%). The difference between right- and left-sided injury rates was shown to be nonsignificant using Fisher exact tests.
Results indicate that, given the study's sample size, side of approach during instrumented, one- or two-level primary ACDF has no significant effect on RLN injury incidence in patients with persistent dysphonia referred for OVC. The definitive answer regarding the true incidence of RLN injury relative to approach side awaits a prospective study with preoperative, immediate postoperative, and periodic OVC in a large, homogeneous population with sufficient numbers of patients with right- and left-sided approaches.
本回顾性研究旨在确定在进行单节段或双节段器械辅助下的初次前路颈椎间盘切除融合术（ACDF）时，手术入路的侧别是否会影响通过观察声带（OVC）诊断的喉返神经（RLN）损伤的发生率。
回顾了1995年1月至2004年2月期间所有接受单节段或双节段器械辅助下初次ACDF手术的患者（418例）的记录。从这些病历中收集的数据包括外科医生、患者人口统计学资料、术前诊断、暴露侧别、融合的椎体节段数，以及因持续性声音嘶哑转诊后通过OVC诊断的RLN损伤情况。右侧暴露患者从手术到OVC的时间与左侧暴露患者相比，差异无统计学意义。418例患者中，278例（66.5%）为右侧暴露，140例（33.5%）为左侧暴露。共发现8例RLN损伤（1.9%）——右侧暴露患者中有5例（1.8%），左侧暴露患者中有3例（2.1%）。使用Fisher精确检验显示，左右侧损伤率之间的差异无统计学意义。
结果表明，鉴于本研究的样本量，在进行单节段或双节段器械辅助下的初次ACDF时，手术入路的侧别对因持续性声音嘶哑转诊接受OVC检查的患者的RLN损伤发生率没有显著影响。关于相对于手术入路侧别的RLN损伤真实发生率的确切答案，有待在一个大型、同质的人群中进行前瞻性研究，该研究需在术前、术后即刻以及定期进行OVC检查，且左右侧入路的患者数量足够。
