Vocal Complications Following Anterior Cervical Discectomy and Fusion: A Systematic Review

Introduction: Postoperative dysphonia is a common complication of anterior cervical discectomy and fusion (ACDF). Despite its prevalence, there are reported discrepancies regarding its clinical features. Here, we sought to review the current literature on dysphonia after ACDF to establish incidence rates, highlight proposed mechanisms of action, and describe effective management strategies.

Methods: A comprehensive search of PubMed, Embase, and Google Scholar was performed using key terms. Inclusion criteria was as follows: published between 2013-2023, subjects over 18 years of age, reports of postoperative voice changes, and at least one postoperative follow-up between one week and 6 months. Endoscopic surgical techniques and/or subjects with a history of cancer, trauma, or deformity to the operated region were excluded. Reviews and meta-analyses were also excluded.

Results: In total, 21 studies were deemed suitable for analysis. Common methods of voice complication evaluation included patient-reported symptoms (10/21), endoscopic laryngoscopy (6/21), and the Voice Handicap Index (VHI-10) (2/21). Incidence rates ranged from 0.3% - 27% with variations based on surgical constructs. Symptom onset occurred within the one week postop, while resolution ranged between 6 weeks to one year postop. Treatment options included short-term steroids (5/21), speech therapy (4/21), and laryngoplasty with vocal cord medialization (5/21). Of the studies, 8 notably reported persistent symptoms as far as 2 years postop, though it is unclear what treatments were utilized. Proposed mechanisms of action included recurrent laryngeal nerve injury due to retraction (13/21), endotracheal tube and cuff pressure (4/21), and postoperative edema (6/21).

Conclusions: Postoperative dysphonia following ACDF is a clinically significant outcome that patients should be counseled about preoperatively and managed postoperatively to avoid long term impairments in quality of life. Involvement of otolaryngologists may help prevent this complication or allow for early detection and symptom management.