Researchers examined the past. For a study, they sought to determine the exact incidence of vocal cord palsy (VCP) induced by earlier anterior cervical spine surgery (ACSS) to help surgeons choose the best technique for revision ACSS. Investigators looked at the records of 64 patients who had their ACSS revised. All patients had a preoperative laryngoscopy to check for VCP and structural abnormalities of the vocal cords. Patients’ characteristics, laryngoscopy results, and symptoms caused by previous recurrent laryngeal nerve damage (voice alteration, foreign body sensation, and chronic aspiration) were noted before revision surgery. The laryngoscopy revealed no full VCP and reduced vocal cord mobility. About 11 patients (17.2%) had symptoms associated with the vocal cords, and 13 (20.3%) had abnormal laryngoscopic findings without VCP. Around 4 patients (6.2%) had vocal cord symptoms as well as abnormal laryngoscopic outcomes at the same time. There were no significant variations in vocal cord-related symptoms between the upper and lower levels at the initial surgical level (C3-4-5 vs C5-6-7). However, in the higher number of groups (≥3 segments), the frequency of vocal cord-related symptoms was substantially higher (P=0.010). In addition, the study found that VCP was rarely diagnosed before revision ACSS, contrary to prior studies. As a result, deciding the approach direction solely based on vocal cord motility can be risky. In patients who have both vocal cord-related symptoms and atypical laryngoscopic outcomes, extra care must be used in determining the approach direction. If necessary, a contralateral technique with a reduced risk of bilateral VCP could be used in other circumstances.
