Brandenburg Medical School Fontane, Campus Bad Saarow, Bad Saarow, Germany.
Department of Neurosurgery, Helios Clinic Bad Saarow, Bad Saarow, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2020 Nov;81(6):508-512. doi: 10.1055/s-0040-1710351. Epub 2020 Aug 10.
Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors.
This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery.
214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient's age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97).
In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics.
喉返神经麻痹（RLNP）是前路椎间盘切除融合术（ACDF）的潜在并发症。ACDF 后 RLNP 的实际发生率以及术后 RLNP 的危险因素仍存在很大争议。本研究的目的是描述 ACDF 连续病例中术后 RLNP 的发生率，并探讨潜在的危险因素。
本回顾性研究纳入了 2005 年至 2019 年在单一神经外科中心接受 ACDF 的患者。作为临床常规的一部分，由独立的耳鼻喉科医生使用内镜喉镜在手术前后检查 RLNP。我们将患者的年龄、性别、体重指数、多节段手术和手术时间作为术后 RLNP 的潜在危险因素进行了检查。
共纳入 214 例连续病例。术前 RLNP 的发生率为 1.4%（3/214），术后 RLNP 的发生率为 9%（19/211）。手术节段为 1 节的占 73.5%（155/211），2 节的占 24.2%（51/211），3 节及以上的占 2.4%（5/211）。所有病例中，4.7%（10/211）为再次手术。原发性手术组（9.0%，18/183）与再次手术组（10.0%，1/10）的 RLNP 发生率无差异（ = 0.91）。术后 RLNP 组与无术后 RLNP 组患者在年龄、性别、体重指数、手术时间或手术节段数等方面均无差异。我们未发现术后 RLNP 与患者年龄、性别、体重指数、手术时间或手术节段数之间存在相关性（比值比在 0.24 至 1.05 之间；p 值在 0.20 至 0.97 之间）。
在本队列中，ACDF 后 RLNP 的发生率为 9.0%。由于没有一个检查变量与 RLNP 的发生有关，这支持了术后 RLNP 可能更多地取决于手术过程中的直接机械操作，而不是特定的患者或手术特征的观点。
