Diagnosis and treatment of postoperative voice complications following anterior cervical discectomy and fusion: a systematic review.

Background: There is a wide discrepancy in the literature regarding the incidence of postoperative dysphonia following ACDF. How postoperative dysphonia is measured is also inconsistent, with many studies relying on patient-reported outcomes rather than diagnostic laryngoscopy. The purpose of this study was to consolidate information regarding dysphonia after ACDF to improve diagnosis and management.

Methods: A comprehensive database search was performed using key terms. Inclusion criteria was as follows: published within 10 years, subjects > 18 years of age, ACDF for treatment of cervical radiculopathy and/or myelopathy, reports of postoperative changes in voice, and at least one postoperative follow-up between one week and six months. Works that included endoscopic surgical techniques and/or subjects with a history of cancer or trauma to the operated region were excluded. Reviews and meta-analyses were also removed from analysis.

Results: Twenty-one eligible studies were analyzed. Evaluation methods varied, with incidence rates ranging from 0.3 to 27%. Symptoms typically arose within one week post-op, persisting up to one year. Treatment modalities included steroids, speech therapy, and laryngoplasty. Mechanisms included recurrent laryngeal nerve injury, endotracheal tube pressure, and postoperative edema.

Conclusions: Postoperative voice complications following ACDF represent a clinically significant outcome that can impact a patient's quality of life. Patients should be counseled preoperatively about the potential risk, and managed postoperatively to mitigate long-term impairments. Involvement of otolaryngologists may help prevent these complications or allow for early detection and management, underscoring the importance of multidisciplinary care in optimizing surgical outcomes.