Oh Lawrence J, Dibas Mahmoud, Ghozy Sherief, Mobbs Ralph, Phan Kevin, Faulkner Harrison
Faculty of Medicine, University of New South Wales, Sydney, Australia.
Sulaiman Al Rajhi Colleges, College of Medicine, Al-Bukayriyah, Saudi Arabia.
J Spine Surg. 2020 Sep;6(3):541-548. doi: 10.21037/jss-20-508.
Recurrent laryngeal nerve (RLN) palsy is a common and potentially debilitating complication of anterior cervical discectomy and fusion (ACDF). The relationship between the risk of RLN palsy and the number of operated levels remains unclear, and no previous studies address potential differences between short- and long-term RLN injury following ACDF.
Electronic searches of PubMed, Cochrane, ScienceDirect and Google Scholar were performed from database inception to June 2019. Relevant studies reporting the rate of RLN palsy for patients undergoing ACDF for cervical spine pathology were identified according to predetermined inclusion and exclusion criteria. Statistical analysis was performed using fixed effects and random effects modelling. I2 and Q statistics were used to explore heterogeneity.
Five studies with a total of 3,514 patients were included in the meta-analysis. The incidence of RLN palsy was found to be 1.2%. There were no statistically significant differences in the rate of RLN palsy between multiple- and single-level ACDF [odds ratio (OR) 1.04; 95% CI: 0.56-1.95; P=0.891, I2=0%]. There were similarly no statistically significant differences in RLN palsy rates for multiple- and single-level ACDF when patients were stratified based on length of follow-up of less than or greater than 12 months.
This analysis suggests that there is no statistically significant association between the number of ACDF operative levels and the risk of short- or long-term RLN palsy.
喉返神经（RLN）麻痹是颈椎前路椎间盘切除融合术（ACDF）常见且可能导致功能障碍的并发症。喉返神经麻痹风险与手术节段数量之间的关系尚不清楚，且此前没有研究探讨ACDF术后短期和长期喉返神经损伤的潜在差异。
从数据库建立至2019年6月，对PubMed、Cochrane、ScienceDirect和谷歌学术进行电子检索。根据预定的纳入和排除标准，确定报告因颈椎病变接受ACDF患者的喉返神经麻痹发生率的相关研究。采用固定效应和随机效应模型进行统计分析。使用I2和Q统计量探讨异质性。
五项研究共纳入3514例患者进行荟萃分析。发现喉返神经麻痹的发生率为1.2%。多节段和单节段ACDF之间喉返神经麻痹发生率无统计学显著差异[比值比（OR）1.04；95%置信区间：0.56 - 1.95；P = 0.891，I2 = ）。根据随访时间小于或大于12个月对患者进行分层时，多节段和单节段ACDF的喉返神经麻痹发生率同样无统计学显著差异。
该分析表明，ACDF手术节段数量与短期或长期喉返神经麻痹风险之间无统计学显著关联。
