Diagnosis and treatment of postoperative voice complications following anterior cervical discectomy and fusion: a systematic review.

Abstract

There is a wide discrepancy in the literature regarding the incidence of postoperative dysphonia following ACDF. How postoperative dysphonia is measured is also inconsistent, with many studies relying on patient-reported outcomes rather than diagnostic laryngoscopy. The purpose of this study was to consolidate information regarding dysphonia after ACDF to improve diagnosis and management. A comprehensive database search was performed using key terms. Inclusion criteria was as follows: published within 10 years, subjects > 18 years of age, ACDF for treatment of cervical radiculopathy and/or myelopathy, reports of postoperative changes in voice, and at least one postoperative follow-up between one week and six months. Works that included endoscopic surgical techniques and/or subjects with a history of cancer or trauma to the operated region were excluded. Reviews and meta-analyses were also removed from analysis. Twenty-one eligible studies were analyzed. Evaluation methods varied, with incidence rates ranging from 0.3 to 27%. Symptoms typically arose within one week post-op, persisting up to one year. Treatment modalities included steroids, speech therapy, and laryngoplasty. Mechanisms included recurrent laryngeal nerve injury, endotracheal tube pressure, and postoperative edema. Postoperative voice complications following ACDF represent a clinically significant outcome that can impact a patient's quality of life. Patients should be counseled preoperatively about the potential risk, and managed postoperatively to mitigate long-term impairments. Involvement of otolaryngologists may help prevent these complications or allow for early detection and management, underscoring the importance of multidisciplinary care in optimizing surgical outcomes.