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

Journal of Orthopaedic Surgery and Research, 2025 · DOI: https://doi.org/10.1186/s13018-025-05464-1 · Published: January 6, 2025

Surgery Orthopedics

Simple Explanation

Anterior cervical discectomy and fusion (ACDF) is a common surgery for neck problems. This review looks at voice problems (dysphonia) that can happen after ACDF. The review found that how voice problems are measured varies, and the rate of these problems ranges widely. Symptoms usually start within a week after surgery and can last up to a year. Managing these voice issues can involve steroids, speech therapy, or surgery on the voice box. The review suggests that having ear, nose, and throat (ENT) doctors involved can help prevent or manage these problems.

Study Duration

Not specified

Participants

Twenty-one eligible studies

Evidence Level

Systematic Review

Key Findings

1
The incidence of voice complications after ACDF varied widely, from 0.3 to 27%, likely due to differing measurement methods.
2
Dysphonia symptom onset typically occurred within the first week post-surgery, with resolution times varying from six weeks to one year.
3
Recurrent laryngeal nerve palsy due to manual retraction was the most commonly described mechanism for postoperative voice changes.

Research Summary

This systematic review consolidates research on dysphonia following ACDF, revealing inconsistencies in prevalence, clinical presentation, and measurement. The variability in reported dysphonia incidence (0.3 to 27%) may stem from differing outcome measures, such as patient-reported symptoms versus laryngoscopy. While most dysphonia cases resolve within 6 months with conservative treatments, some patients experience persistent symptoms, highlighting the need for optimal treatment strategies.

Practical Implications

Preoperative Counseling

Patients undergoing ACDF should be counseled about the potential risk of postoperative voice complications.

Multidisciplinary Care

Early involvement of otolaryngologists may help in preventing and managing postoperative dysphonia.

Standardized Assessment

Future research should focus on standardizing the measurement and reporting of postoperative voice complications.

Study Limitations

1
Variability across studies in design, patient populations, interventions, and outcome measurements.
2
Potential exclusion of relevant studies due to search strategy limitations.
3
Inclusion limited to studies published from 2013 to 2023, excluding earlier findings.

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