Wu Cheng Han, Yang Eugene Wei Ren, Lor Kelvin Kah Ho
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore.
Biomedicine (Taipei). 2021 Mar 1;11(1):51-55. doi: 10.37796/2211-8039.1114. eCollection 2021.
Revision anterior cervical spine surgery has a higher risk of recurrent laryngeal nerve palsy (RLNP). We describe a unique case of an isolated RLNP contralateral to the side of the surgical approach in a patient who underwent revision anterior cervical discectomy and fusion (ACDF) for cervical myelopathy, and in whom pre-operative laryngoscopic evaluation had excluded a pre-existing occult RLNP. Scarring around the recurrent laryngeal nerve at the previous surgical site may have rendered it less mobile, resulting in it being more susceptible to compression from an inflated endotracheal tube (ETT) cuff or traction from surgical retractors. This case illustrates that acute RLNP can rarely occur contralateral to the side of surgical approach in the setting of revision surgery. Surgeons performing revision ACDF can consider approaching from the same side as the index surgery or a posterior approach to reduce the risk of developing bilateral RLNP.
颈椎前路翻修手术发生喉返神经麻痹（RLNP）的风险更高。我们描述了一例独特的病例，一名因颈椎脊髓病接受颈椎前路椎间盘切除融合术（ACDF）翻修手术的患者，在手术入路对侧出现孤立性RLNP，且术前喉镜检查排除了术前存在隐匿性RLNP。先前手术部位喉返神经周围的瘢痕可能使其活动度降低，导致其更容易受到充气气管内插管（ETT）套囊的压迫或手术牵开器的牵拉。该病例表明，在翻修手术中，急性RLNP很少会发生在手术入路的对侧。进行ACDF翻修手术的外科医生可以考虑从初次手术的同一侧入路或后路入路，以降低发生双侧RLNP的风险。
