From the Guidelines
Hoarseness after anterior cervical discectomy is a common complication that typically resolves within 1-3 months without specific treatment. The primary recommendation is watchful waiting with voice rest, adequate hydration, and avoiding irritants like smoking or excessive talking 1. If symptoms persist beyond 3 months, referral to an otolaryngologist is warranted for laryngoscopy to assess for recurrent laryngeal nerve injury. Patients may benefit from speech therapy exercises in the interim, focusing on gentle vocal techniques.
Some key points to consider in the management of hoarseness after anterior cervical discectomy include:
- The incidence of hoarseness immediately following anterior cervical spine surgery may be as high as 50 percent 1
- Recurrent laryngeal nerve paralysis has been reported to range from 1.27 percent to 2.7 percent 1
- Assessment with laryngoscopy suggests an even higher incidence of voice problems 1
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily) may help reduce laryngeal inflammation, while proton pump inhibitors such as omeprazole (20mg daily) can be useful if reflux is contributing to symptoms.
- Hoarseness occurs in 2-30% of cases due to traction injury, compression, or direct trauma to the recurrent laryngeal nerve during surgery, with the right side being more vulnerable due to its anatomical course 1.
It is essential to reassure patients while monitoring for complete resolution, as permanent hoarseness occurs in less than 3% of cases 1.
From the Research
Hoarseness after Anterior Cervical Discectomy
- Hoarseness is a common postoperative complication after anterior cervical spine surgery, with an incidence of 4.9% as reported in the literature 2.
- The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve, but other causes such as pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, and arytenoid cartilage dislocation should also be considered 3.
- Arytenoid dislocation is a possible cause of prolonged hoarseness in patients after anterior cervical discectomies, and it is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury 3.
- Patient age is a significant predictor of postoperative dysphagia, with an odds ratio of 1.113 per year of age, but not necessarily a predictor of hoarseness 2.
- Endotracheal cuff pressure after retractor placement was correlated to postoperative voice hoarseness, dysphagia, and aspiration symptoms in a prospective study of 108 patients undergoing anterior cervical discectomy and fusion (ACDF) surgery 4.
- Voice hoarseness does not necessarily indicate recurrent laryngeal nerve injury after ACDF, but may be caused by compressive forces on laryngeal tissue during retraction or intubation 4.
- The incidence of vocal fold paralysis (VFP) after ACDF is around 5%, and most cases (83.3%) have complete resolution within 12 months 5.
- Dysphonia and dysphagia are common complications following the anterior approach to the cervical spine, with an incidence of 51% and 60%, respectively, in a study of 497 patients 6.