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Approach side during anterior cervical discectomy

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Approach side during anterior cervical discectomy Approach side during anterior cervical discectomy Presentation Transcript

  • 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
    • Case of the week:
    • 45F / RHD
    • Sept 2010 – acute Rt C6 paraesthesia and neck pain
    • Rt C6 perineural injection – minimal effect.
    • Normal power & deep tendon reflexes.
  •  
    • Left sided C5/6 ACDF
    • Uneventful procedure.
    • Postoperative sore throat.
    • Resolution of pre-op symptoms.
  • 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
    • Searchable question
    • “ Does the side of the approach during anterior cervical surgery have an effect on the incidence of recurrent laryngeal nerve injury?”
    • Databases
    • Medline – using MeSH
    • Cochrane for systematic reviews or clinical trials
    • Scopus using keywords
  •  
    • Medline
    • 21 articles.
    • 7 highly relevant.
    • 8 not relevant.
    • Scopus
    • 85 articles total.
    • further 4 highly relevant.
    • Cochrane
    • No reviews
    • 2 clinical trials – ETT cuff pressures
    • Level of evidence
    • Level 1: 0
    • Level 2: 0 * (possibly one if combining two different studies from same group)
    • 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
    • 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%
    • 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
    • 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
    • Conclusion and further analysis
    • No level 1 evidence supporting the reported low incidence of recurrent laryngeal nerve injury with the left sided approach.
    • Right sided approach convenient for right handed surgeons.
    • Advance Scholar’s preference to approach lesions from the contralateral side.
    • Excessive retraction - ?culprit
    • Role of reducing ETT cuff pressure during retraction – Clinical trials in Cochrane database -> opposite conclusions.
    • The search was effective in reviewing the current literature on the subject.