Complications of Anterior Discectomy
Complications of Anterior Discectomy – which side is better to operate on? The left or the right side of the neck?
Well, it appears based on the study below that each side of the neck is equally risky for complications.
Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury.
OBJECT: This retrospective study was designed to determine whether side of approach during instrumented, one- or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC).
METHODS: Records of all patients who underwent one- or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed.
Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of recurrent laryngeal nerve injury diagnosed by observation of the vocal cords after referral for persistent dysphonia.
Time from surgery to OVC for patients with right-sided exposures was not statistically different from that for patients with left-sided exposures.
Of 418 patients, 278 (66.5%) had right-sided exposures and 140 (33.5%) had left-sided exposures.
Eight RLN injuries (1.9%) were noted-five in patients with right-sided exposures (1.8%) and three in patients with left-sided exposures (2.1%).
The difference between right- and left-sided injury rates was shown to be nonsignificant using Fisher exact tests.
CONCLUSIONS: Results indicate that, given the study’s sample size, side of approach during instrumented, one- or two-level primary ACDF has no significant effect on recurrent laryngeal nerve injury incidence in patients with persistent dysphonia referred for observation of the vocal cords .
The definitive answer regarding the true incidence of recurrent laryngeal nerve injury relative to approach side awaits a prospective study with preoperative, immediate postoperative, and periodic OVC in a large, homogeneous population with sufficient numbers of patients with right- and left-sided approaches.
Source: Journal Neurosurg Spine. 2006 Apr;4(4):273-7.
