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Evidence based surgical meeting: “ Effect of approach side during anterior cervical discectomy and fusion on the incidence...
<ul><li>Case of the week: </li></ul><ul><li>45F / RHD </li></ul><ul><li>Sept 2010 – acute Rt C6 paraesthesia and neck pain...
 
<ul><li>Left sided C5/6 ACDF </li></ul><ul><li>Uneventful procedure. </li></ul><ul><li>Postoperative sore throat. </li></u...
Searchable question P  – pts with cervical disc protrusion I  – anterior cervical discectomy and fusion C  – side of the a...
<ul><li>Searchable question </li></ul><ul><li>“ Does the side of the approach during anterior cervical surgery have an eff...
 
<ul><li>Medline </li></ul><ul><li>21 articles. </li></ul><ul><li>7 highly relevant. </li></ul><ul><li>8 not relevant. </li...
<ul><li>Level of evidence </li></ul><ul><li>Level 1: 0 </li></ul><ul><li>Level 2: 0 * (possibly one if combining two diffe...
<ul><li>Beutler WJ et al. Recurrent Laryngeal Nerve Injury With Anterior Cervical Spine Surgery - Risk With Laterality of ...
<ul><li>Conclusion and further analysis </li></ul><ul><li>No level 1 evidence supporting the reported low incidence of rec...
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Approach side during anterior cervical discectomy

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Transcript of "Approach side during anterior cervical discectomy"

  1. 1. Evidence based surgical meeting: “ Effect of approach side during anterior cervical discectomy and fusion on the incidence of dysphonia/ hoarseness” Scholar: Dr Stavros KOUSTAIS Advanced Scholar: Dr Kevin SEEX Date: 7 th April 2011
  2. 2. <ul><li>Case of the week: </li></ul><ul><li>45F / RHD </li></ul><ul><li>Sept 2010 – acute Rt C6 paraesthesia and neck pain </li></ul><ul><li>Rt C6 perineural injection – minimal effect. </li></ul><ul><li>Normal power & deep tendon reflexes. </li></ul>
  3. 4. <ul><li>Left sided C5/6 ACDF </li></ul><ul><li>Uneventful procedure. </li></ul><ul><li>Postoperative sore throat. </li></ul><ul><li>Resolution of pre-op symptoms. </li></ul>
  4. 5. Searchable question P – pts with cervical disc protrusion I – anterior cervical discectomy and fusion C – side of the approach O – dysphonia / hoarseness / recurrent laryngeal nerve palsy OR P – pts undergoing anterior cervical surgery I – right side approach C – left side approach O - dysphonia / hoarseness / recurrent laryngeal nerve palsy
  5. 6. <ul><li>Searchable question </li></ul><ul><li>“ Does the side of the approach during anterior cervical surgery have an effect on the incidence of recurrent laryngeal nerve injury?” </li></ul><ul><li>Databases </li></ul><ul><li>Medline – using MeSH </li></ul><ul><li>Cochrane for systematic reviews or clinical trials </li></ul><ul><li>Scopus using keywords </li></ul>
  6. 8. <ul><li>Medline </li></ul><ul><li>21 articles. </li></ul><ul><li>7 highly relevant. </li></ul><ul><li>8 not relevant. </li></ul><ul><li>Scopus </li></ul><ul><li>85 articles total. </li></ul><ul><li>further 4 highly relevant. </li></ul><ul><li>Cochrane </li></ul><ul><li>No reviews </li></ul><ul><li>2 clinical trials – ETT cuff pressures </li></ul>
  7. 9. <ul><li>Level of evidence </li></ul><ul><li>Level 1: 0 </li></ul><ul><li>Level 2: 0 * (possibly one if combining two different studies from same group) </li></ul>
  8. 10. <ul><li>Beutler WJ et al. Recurrent Laryngeal Nerve Injury With Anterior Cervical Spine Surgery - Risk With Laterality of Surgical Approach. SPINE 26(12):1337–1342, 2001 – NO ASSOCIATION </li></ul><ul><li>Jung A et al. Recurrent laryngeal nerve palsy during anterior cervical spine surgery: a prospective study. J Neurosurg Spine 2:123-127, 2005. – laryngoscopy / Right side approach / At D3 incidence 24.2% - at 3/12 10.8% </li></ul><ul><li>Kilburg C et al. Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury. J Neurosurg Spine 4:273-277, 2006. – NO SIGNIFICANT DIFFERENCE </li></ul><ul><li>Jung A and Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study. Neurosurgery 67(1):10-15, 2010 – LEFT SIDED APPROACH REDUCES THE INCIDENCE / comparing with data from 2005 / advocate ETT cuff pressure reduction </li></ul>
  9. 11. <ul><li>Conclusion and further analysis </li></ul><ul><li>No level 1 evidence supporting the reported low incidence of recurrent laryngeal nerve injury with the left sided approach. </li></ul><ul><li>Right sided approach convenient for right handed surgeons. </li></ul><ul><li>Advance Scholar’s preference to approach lesions from the contralateral side. </li></ul><ul><li>Excessive retraction - ?culprit </li></ul><ul><li>Role of reducing ETT cuff pressure during retraction – Clinical trials in Cochrane database -> opposite conclusions. </li></ul><ul><li>The search was effective in reviewing the current literature on the subject. </li></ul>

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