Abstract
Problem: The true incidence of vocal fold dysfunction following anterior cervical disk fusion (ACDF) is unknown, with few studies documenting laryngeal examination before and after surgery. Consequently, the effect of potential interventions such as limiting endotracheal tube cuff pressure and its effect on this incidence cannot be properly assessed.
Methods: This study was a randomized, prospective clinical trial performed at an academic institution. Over a 4-year time period, patients undergoing primary ACDF surgery volunteered to participate. Preoperative and postoperative laryngeal endoscopy was performed. Recorded examinations were reviewed by independent laryngologists for determination of vocal fold mobility. Patients were randomized intraoperatively into 2 groups: a control group and an intervention group. Patients in the intervention group had endotracheal tube cuff pressures maintained below 20 mmHg throughout the surgical procedure.
Results: One hundred patients were studied and randomized into 2 groups of 50 patients each. In the acute postoperative period, vocal cord paresis was seen in 8% and paralysis in 4% of studied patients. There was no significant difference in paresis or paralysis rates of the vocal fold on the side of surgery between the control and intervention groups.
Conclusion: Vocal cord dysfunction is a common complication of ACDF surgery that can result in significant patient morbidity. Manipulating endotracheal tube cuff pressures did not decrease the risk of intraoperative recurrent laryngeal nerve injuries.
Significance: This study demonstrates the true incidence of vocal fold dysfunction after ACDF surgery and that this incidence is unaltered by intraoperative interventions such as reducing endotracheal tube cuff pressures.
Support: None reported.
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