Nerve Damage after Anterior Neck Surgery

Many patients suffer from hoarseness after anterior cervical spine (neck) surgery. The problem could be nerve palsy. By opening the neck up from the front, surgeons avoid damaging the spinal cord. Instead, there’s a risk that the recurrent laryngeal nerve (RLN) can be damaged. When this happens, the vocal cords are affected. How often does this occur? That’s the focus of this study from an ear, nose, and throat center in Germany.

The researchers didn’t just rely on symptoms of hoarseness and difficulty swallowing to test for nerve palsy. They used a laryngoscope to look at the vocal cords before and after the neck surgery. All patients in the study had anterior cervical spine surgery to remove a disc or fuse the spine. Vocal cord function was also measured.

The authors report two out of 123 patients (1.6 percent) had RLN without hoarseness before surgery. Another 24 percent (some with symptoms, some without) were affected after surgery. Many patients still had nerve impairment three months later. The recovery rate was much lower than expected.

The results of this study have led researchers to consider several options:

  • Surgeons should find and protect the RLN when doing anterior cervical spine surgery.
  • It might be better to do the surgery from the left side of the neck (instead of the
    right side) to protect the nerve.
  • Checking the vocal cords may be a good idea before surgery when there are significant
    risk factors.
  • Pressure on the RLN from the endotracheal tube cuff can be reduced after the tissues are pulled out of the way; this will take pressure off the RLN that could damage it.

    The overall rate of RLN palsy has been reduced during thyroid surgery from 20 percent in 1950 to around four percent today. The authors suggest the same can be done for anterior cervical spine surgery.