Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T2S8.
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T2S8.
Spine J. 2014 Jul 1;14(7):1332-42. doi: 10.1016/j.spinee.2014.02.017. Epub 2014 Mar 13.
Vocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied.
To conduct a systematic review to identify the incidence, risk, and interventions for VCP after anterior cervical spine surgery.
This is a qualitative systematic literature review.
Prospective and retrospective trials of patients undergoing anterior cervical spine surgery that reported on postoperative VCP or recurrent laryngeal nerve palsy.
Primary: incidence of VCP after anterior cervical spine surgery; secondary: risk factors and interventions for prevention of VCP after anterior cervical spine surgery.
Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews for clinical studies reporting VCP in anterior cervical spine surgery, limited to studies published between 1995 and June 2013 in English and French languages. After selection of studies independently by two review authors, data on incidence, risk, and interventions were extracted. Qualitative analysis was performed on three domains: quality of studies, strength of evidence, and impact of interventions.
Our search has identified 187 abstracts, and 34 studies met our inclusion criteria. The incidence of VCP ranges from 2.3% to 24.2%. Significant heterogeneity in study design and definition of VCP were used in the published studies. There is good evidence that reoperation increases the risk of VCP. One study of moderate strength suggests that operating from the right side may increase the risk of VCP. Among the interventions studied, endotracheal tube (ETT) cuff pressure monitoring with deflation during retraction has shown to reduce the incidence from 6% to 2%, but this result was not confirmed by randomized control trials. Limited evidence exists for other interventions of intraoperative electromyographic monitoring and methylprednisolone.
Vocal cord palsy is a significant morbidity after anterior cervical surgery with incidence up to 24.2% in the immediate postoperative period, with a higher risk in reoperation of the anterior cervical spine. Moderate evidence exists for ETT cuff pressure adjustment in preventing this complication.
声带麻痹（VCP）是颈椎前路手术后的一种已知并发症。然而，对于这种并发症的真实发生率和干预措施，尚未得到很好的研究。
进行系统综述，以确定颈椎前路手术后 VCP 的发生率、风险和干预措施。
这是一项定性的系统文献综述。
对接受颈椎前路手术的患者进行前瞻性和回顾性研究，这些研究报告了术后 VCP 或喉返神经麻痹。
颈椎前路手术后 VCP 的发生率；次要结局：颈椎前路手术后 VCP 预防的危险因素和干预措施。
在 Ovid Medline、EMBASE、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库中进行了电子检索，检索内容为颈椎前路手术中报告 VCP 的临床研究，检索时间限定在 1995 年至 2013 年 6 月间发表的英文和法文文献。经过两位评审员独立筛选研究后，提取关于发生率、风险和干预措施的数据。对三个领域进行了定性分析：研究质量、证据强度和干预效果。
我们的检索共确定了 187 篇摘要，有 34 篇研究符合纳入标准。VCP 的发生率范围为 2.3%至 24.2%。发表的研究中，研究设计和 VCP 的定义存在显著的异质性。有很好的证据表明再次手术会增加 VCP 的风险。一项强度中等的研究表明，从右侧手术可能会增加 VCP 的风险。在所研究的干预措施中，气管内导管（ETT）套囊压力监测并在牵开时放气，可将发生率从 6%降至 2%，但这一结果尚未被随机对照试验所证实。对于术中肌电图监测和甲基强的松龙等其他干预措施，仅有有限的证据支持。
颈椎前路手术后声带麻痹是一种严重的发病率，在术后即刻的发生率高达 24.2%，颈椎前路再次手术的风险更高。有中等强度的证据表明，调整 ETT 套囊压力可以预防这种并发症。
