Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery

• The incidence of dysphonia at one month following ACSS was 19.3%.
• Most dysphonia resolved with time, very rare cases needed specific treatments.
• Approaching at lower cervical levels was a risk factor for dysphonia.

ObjectivesThe present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors.Clinical materials and methodsPatients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital’s patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively.Results45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (P < 0.001). This association was not weakened in multiple logistic regression analysis (OR 2.348, 95% CI 1.467–3.659, P < 0.001).ConclusionThe incidence of early dysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor.