Erwood Matthew S, Hadley Mark N, Gordon Amber S, Carroll William R, Agee Bonita S, Walters Beverly C
Departments of 1 Neurosurgery and.
Surgery, Division of Otolaryngology, University of Alabama at Birmingham, Alabama.
J Neurosurg Spine. 2016 Aug;25(2):198-204. doi: 10.3171/2015.9.SPINE15187. Epub 2016 Mar 25.
OBJECTIVE Recurrent laryngeal nerve (RLN) injury is one of the most frequent complications of anterior cervical discectomy and fusion (ACDF) procedures. The frequency of RLN is reported as 1%-11% in the literature. (4 , 15) The rate of palsy after reoperative ACDF surgery is not well defined. This meta-analysis was performed to review the current medical evidence on RLN injury after ACDF surgery and to determine a relative rate of RLN injury after reoperative ACDF. METHODS MEDLINE, PubMed, and Google Scholar searches were performed using several key words and phrases related to ACDF surgery. Included studies were written in English, addressed revisionary ACDF surgery, and studied outcomes of RLN injury. Statistical analysis was then performed using a random-effects model to calculate a pooled rate of RLN injury. The heterogeneity of the studies was assessed using Cochran's Q statistic and I(2) statistic, and a funnel plot was constructed to evaluate publication bias. RESULTS The search initially identified 345 articles on this topic. Eight clinical articles that met all inclusion criteria were included in the meta-analysis. A total of 238 patients were found to have undergone reoperative ACDF. Thirty-three of those patients experienced an RLN injury. This analysis identified a rate of RLN injury in the literature after reoperative ACDF of 14.1% (95% confidence interval [CI] 9.8%-19.1%). CONCLUSIONS The rate of RLN palsy of 14.1% was greater than any published rate of RLN injury after primary ACDF operations, suggesting that there is a greater risk of hoarseness and dysphagia with reoperative ACDF surgeries than with primary procedures as reported in these studies.
目的 喉返神经（RLN）损伤是颈椎前路椎间盘切除融合术（ACDF）最常见的并发症之一。文献报道RLN损伤的发生率为1% - 11%。（4, 15）再次行ACDF手术后的神经麻痹发生率尚无明确界定。本荟萃分析旨在回顾当前关于ACDF手术后RLN损伤的医学证据，并确定再次行ACDF手术后RLN损伤的相对发生率。方法 使用与ACDF手术相关的几个关键词和短语在MEDLINE、PubMed和谷歌学术上进行检索。纳入的研究需用英文撰写，涉及翻修性ACDF手术，并研究RLN损伤的结果。然后使用随机效应模型进行统计分析，以计算RLN损伤的合并发生率。使用Cochran's Q统计量和I(2)统计量评估研究的异质性，并构建漏斗图以评估发表偏倚。结果 检索最初识别出345篇关于该主题的文章。八项符合所有纳入标准的临床文章被纳入荟萃分析。共发现238例患者接受了再次ACDF手术。其中33例患者发生了RLN损伤。该分析确定再次行ACDF手术后文献中RLN损伤的发生率为14.1%（95%置信区间[CI] 9.8% - 19.1%）。结论 RLN麻痹发生率为14.1%，高于任何已发表的初次ACDF手术后RLN损伤发生率，表明如这些研究所报道，再次行ACDF手术比初次手术发生声音嘶哑和吞咽困难的风险更大。
