Vocal fold paralysis after anterior cervical diskectomy and fusion

Objective: The anterior approach to the cervical spine now serves as the su rgical access of choice for cervical spine disease. Vocal fold paralysis (V FP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis. Study Design: Ret rospective. Methods: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of t he patients with documented VFP after surgery was then performed. Results: Over the given time period 411 ACDFs were performed and 21 patients with th is complication were identified (5%). All 21 patients had right-sided appro aches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP, Symptoms included hoarseness (18), persistent cough (7), aspiration ( 13), and dysphagia (7), The patient with bilateral VFP presented with strid er and respiratory distress requiring tracheotomy, The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83. 3%) had complete resolution within 12 months. One patient had recovery afte r 15 months. All patients were treated conservatively with speech and swall owing therapy. One patient required Gelfoam injection and another medializa tion thyroplasty, both for aspiration symptoms. Conclusions: The data sugge st that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow-up and speech therapy for symptomatic patients. Medialization should be considered in patients with a spiration or persistent problems.