Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation

1999 ◽  
Vol 91 (2) ◽  
pp. 170-174 ◽  
Author(s):  
W. Scott Jellish ◽  
Randy L. Jensen ◽  
Douglas E. Anderson ◽  
John F. Shea
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Cuff Pressure ◽  
Laryngeal Nerve ◽  
Emg Activity ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Posterior Pharynx ◽  
Fine Print

Object. Recurrent laryngeal nerve (RLN) injury occurs after anterior cervical spine procedures. In this study the authors used intraoperative electromyographic (EMG) monitoring of the posterior pharynx as a surrogate for RLN function and monitored endotracheal tube (ET) cuff pressure to determine if there was an association between these variables and clinical outcome. Methods. Sixty patients in whom anterior cervical spine procedures were to be performed comprised the study population. After intubation, the ET cuff was adjusted to a just-seal volume and attached to a pressure monitor. A laryngeal surface electrode was placed in the posterior pharynx, and spontaneous EMG activity was monitored throughout the procedure. Cuff pressures and EMG activity were recorded during neck retraction and when EMG activity increased 20% above baseline. Patients were divided into two groups: those with sore throat/dysphonia and those without symptoms. Cuff pressures and EMG values were compared between groups, and the differences were correlated with clinical outcome. Conclusions. Hoarseness immediately after surgery was reported in 38% of patients whereas 15% exhibited severe symptoms. In symptomatic patients the period of intubation had been longer, and the ET cuff pressures had been elevated. In most patients EMG activity increased during insertion of the retractor and decreased after its removal. In these patients a greater number of episodes of elevated EMG activity during surgery were also noted. Two patients experienced prolonged hoarseness, and one required teflon injections of the vocal fold. This patient's EMG activity increased (15–18 times baseline) during surgery. In the few patients who were symptomatic with increased EMG activity, neither the timing nor direction of change could be associated with symptoms. Intubation time and elevated ET cuff pressure were the most important contributors to dysphonia and sore throat after anterior cervical spine surgery.

Recurrent laryngeal nerve palsy during anterior cervical spine surgery: a prospective study

2005 ◽  
Vol 2 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Axel Jung ◽  
Johannes Schramm ◽  
Kai Lehnerdt ◽  
Claus Herberhold
Keyword(s):  
Cervical Spine ◽  
Prospective Study ◽  
Spine Surgery ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
True Incidence ◽  
Anterior Cervical Spine Surgery ◽  
A Prospective Study ◽  
Fine Print

Object. Recurrent laryngeal nerve (RLN) palsy is a well-known complication of cervical spine surgery. Nearly all previous studies were performed without laryngoscopy in asymptomatic patients. This prospective study was undertaken to discern the true incidence of RLN palsy. Because not every RLN palsy is associated with hoarseness, the authors conducted a prospective study involving the use of pre- and postoperative laryngoscopy. Methods. Prior to anterior cervical spine surgery preoperative indirect laryngoscopy was performed in 123 patients to evaluate the status of the vocal cords as a sign of function of the RLN. To assess postoperative status in 120 patients laryngoscopy was repeated, and in cases of vocal cord malfunction follow-up examination was conducted 3 months later. In the group of 120 patients who attended follow-up examination, two (1.6%) had experienced a preoperative RLN palsy without hoarseness. Postoperatively the rate of clinically symptomatic RLN palsy was 8.3%, and the incidence of RLN palsy not associated with hoarseness (that is, clinically unapparent without laryngoscopy) was 15.9% (overall incidence 24.2%). At 3-month follow-up evaluation the rate had decreased to 2.5% in cases with hoarseness and 10.8% without hoarseness. Thus, the overall rate of early persisting RLN palsy was 11.3%. Conclusions. Laryngoscopy revealed that the true incidence of initial and persisting RLN palsy after anterior cervical spine surgery was much higher than anticipated. Especially in cases without hoarseness this could be proven, but the initial incidence of hoarseness was higher than expected. Only one third of new RLN palsy cases could be detected without laryngoscopy. Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. The true rate of RLN palsy underscores the necessity to reevaluate the surgery- and intubation-related techniques for anterior cervical spine surgery and to reassess the degree of presurgical patient counseling.

Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery

2002 ◽  
Vol 97 (2) ◽  
pp. 176-179 ◽  
Author(s):  
Jebadurai Ratnaraj ◽  
Alexandre Todorov ◽  
Tom McHugh ◽  
Mary Ann Cheng ◽  
Carl Lauryssen
Keyword(s):  
Cervical Spine ◽  
Treatment Group ◽  
Sore Throat ◽  
Spine Surgery ◽  
Endotracheal Tube Cuff ◽  
Content Type ◽  
Tube Cuff ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Fine Print

Object. The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction. Methods. Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively. No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p < 0.05). Sixty-five percent of the women experienced sore throat compared with 35% of the men (p < 0.05). At 24 hours, longer retraction time correlated with development of dysphagia (p < 0.05, r2 = 0.61). At 24 hours, hoarseness was present in 65% of women and 20% of men (p < 0.05). Conclusions. The results of this study suggest the following three predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.

scholarly journals A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery

2017 ◽  
Vol 7 (1_suppl) ◽  
pp. 7S-11S ◽  
Author(s):  
Zachary J. Tempel ◽  
Justin S. Smith ◽  
Christopher Shaffrey ◽  
Paul M. Arnold ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Nerve Injury ◽  
Spine Surgery ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Laryngeal Nerve Injury

The impact of minimally invasive cervical spine surgery

2004 ◽  
Vol 1 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Tim E. Adamson
Keyword(s):  
Cervical Spine ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Cervical Radiculopathy ◽  
Foraminal Stenosis ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
The Impact ◽  
Safe Treatment Option ◽  
Fine Print

✓ Since 1997, cervical endoscopic laminoforaminotomy (CELF) has been an effective and safe treatment option for unilateral cervical radiculopathy secondary to disc herniation or foraminal stenosis. The development of the surgical technique is reviewed and recent outcomes discussed. Its impact is addressed in relation to the patient and surgeon.

scholarly journals How to Reduce Recurrent Laryngeal Nerve Palsy in Anterior Cervical Spine Surgery

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Axel Jung ◽  
Johannes Schramm
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Cuff Pressure ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Control Group ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Group A ◽  
Group B ◽  
Additional Reduction

Abstract BACKGROUND Recurrent laryngeal nerve palsy (RLNP) occurs as a complication during anterior cervical spine surgery. In 2005 the authors demonstrated the high incidence of asymptomatic RLNP in a right-sided approach. OBJECTIVE This follow-up prospective observational study was designed to test 2 options said to reduce the rate of RLNP: reduced endotracheal cuff pressure and sinistral approach. METHODS Two hundred forty-two patients in whom anterior cervical spine surgery was performed were examined postoperatively with indirect laryngoscopy to evaluate the status of the vocal cords. All patients had a left-sided approach but 1 group (A, 149 patients) was operated on with an additional reduction of endotracheal cuff pressure to below 20 mm Hg. In 93 patients we could not reduce the cuff pressure. This group served as a control group (B). Both groups were compared with a historic control group with a right-sided approach and no cuff pressure reduction. In cases of vocal cord malfunction a follow-up examination was done 3 months later. RESULTS Group A (low cuff pressure) had a total rate of persisting symptomatic and asymptomatic RLNP of 1.3% and group B had a rate of 6.5% (normal cuff pressure). Compared with the historic study (N = 120) with a right-sided approach and a total rate of persisting RLNP of 13.3% in the left-sided approach, a marked reduction to 6.5% and 1.3% with an additional reduction of cuff pressure was seen. CONCLUSION The left-sided approach in anterior cervical spine surgery reduces the incidence of postoperative and permanent RLNP significantly. Endotracheal cuff pressure reduction used additionally decreases the rate of RLNP even more. These results indicate that anterior cervical spine surgery should be performed with a left-sided approach and, if possible, with an additional reduction of the endotracheal cuff pressure while the retractors are inserted.

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