Curry Adrian L, Young William F
Morehouse College, Atlanta, GA.
Fort Wayne Neurological Center, Fort Wayne, IN ; Indiana University School of Medicine, Fort Wayne Center, Fort Wayne, IN.
Int J Spine Surg. 2013 Dec 1;7:e81-3. doi: 10.1016/j.ijsp.2013.05.002. eCollection 2013.
Patients who experience a recurrent laryngeal nerve injury (RLI) after undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure may eventually become asymptomatic. If patients with an asymptomatic vocal cord abnormality undergo a subsequent ACDF they may be at risk for developing bilateral vocal cord paralysis (VCP). Bilateral VCP is a potentially life threatening problem, requiring emergent tracheotomy in some cases. A program of referring patients for preoperative laryngoscopic examinations (PLE) who were being considered for a revision ACDF was instituted. This study reviews the results of these examinations and determines if the information gained impacted management.
Patients who were referred for PLE prior to revision ACDF were identified from a prospectively maintained database during the period 2004 - 2010. All patients underwent examinations by an Otorhinolaryngologist specialist (ENT) using a nasopharyngoscope in combination with video stroboscopic examination.
23 patients were identified as having a PLE and subsequent revision ACDF. 18 patients underwent a single level ACDF and 5 patients underwent a previous 2 level surgery. Significant findings were found in 4 patients. 2 patients presented with asymptomatic VCP and 2 patients with chronic hoarseness. One was found with VCP and the other with a vocal cord mass. The revision procedures were performed on the same side as the previous ACDF.
17.3% of patients undergoing PLE exhibited abnormalities, affecting decision-making regarding side of approach for revision ACDF. PLE is a simple and effective way of screening patients for abnormalities prior to revision ACDF surgery.
接受颈椎前路椎间盘切除融合术（ACDF）后发生喉返神经损伤（RLI）的患者最终可能无症状。如果无症状声带异常的患者随后接受ACDF手术，他们可能有发生双侧声带麻痹（VCP）的风险。双侧VCP是一个潜在的危及生命的问题，在某些情况下需要紧急气管切开术。因此制定了一项计划，即对考虑进行ACDF翻修手术的患者进行术前喉镜检查（PLE）。本研究回顾了这些检查的结果，并确定所获得的信息是否影响了治疗决策。
从2004年至2010年期间前瞻性维护的数据库中识别出在ACDF翻修术前被转诊进行PLE的患者。所有患者均由耳鼻喉科专家（ENT）使用鼻咽喉镜结合视频频闪喉镜检查进行检查。
23例患者被确定进行了PLE及随后的ACDF翻修手术。18例患者接受了单节段ACDF手术，5例患者之前接受过双节段手术。4例患者有显著发现。2例患者表现为无症状VCP，2例患者有慢性声音嘶哑。其中1例发现有VCP，另1例发现有声带肿物。翻修手术在与之前ACDF手术相同的一侧进行。
接受PLE检查的患者中有17.3%表现出异常，这影响了ACDF翻修手术入路侧的决策。PLE是在ACDF翻修手术前筛查患者是否存在异常的一种简单有效的方法。
