Our Summary

This research paper discusses the debate on whether the side of the body that a certain type of neck surgery (anterior cervical discectomy and fusion, or ACDF) is performed on can influence the risk of a specific nerve condition (recurrent laryngeal nerve palsy, or RLNP). This nerve condition can affect voice and swallowing. The debate goes back to the 1950s when the surgery was first introduced for treating neck and arm pain.

The nerves in question have slightly different paths in the lower neck, which is due to differences when the person was developing as an embryo. Some researchers believe that doing the surgery from the right side of the neck might make it more likely for the patient to get RLNP. However, more recent studies haven’t found a clear difference in risk between operating from the right or the left side.

The authors suggest that the belief in a higher risk with a right-sided approach may have come from a mix of the theoretical risk based on nerve anatomy and the early experiences of those who first used this surgical method.

FAQs

  1. Does the sidedness of the approach during an anterior cervical discectomy and fusion (ACDF) procedure influence the risk of recurrent laryngeal nerve palsy (RLNP)?
  2. What is the historical context surrounding the introduction of ACDF, particularly with regard to the risk of RLNP?
  3. Why have the modern surgical series not shown a clear risk of RLNP with a right- versus left-sided approach in ACDF?

Doctor’s Tip

A helpful tip a doctor might tell a patient about discectomy is to follow post-operative instructions carefully, including proper wound care, activity restrictions, and physical therapy exercises to promote healing and reduce the risk of complications. It is important to communicate any new or worsening symptoms to your healthcare provider and attend all follow-up appointments to monitor your recovery progress.

Suitable For

Patients who are typically recommended for discectomy are those who have failed conservative treatments such as physical therapy, medications, and injections for conditions such as herniated discs, degenerative disc disease, spinal stenosis, and radiculopathy. These patients may experience symptoms such as severe neck or back pain, arm or leg pain, weakness, numbness, and tingling. They may also have imaging studies that show compression of nerves or spinal cord. Discectomy may be recommended to alleviate symptoms, improve function, and prevent further nerve damage.

Timeline

  • Before discectomy: The patient experiences symptoms of radicular pain, such as shooting pain, numbness, or weakness in the arms or hands. They may undergo diagnostic tests such as MRI or CT scans to confirm a herniated disc in the cervical spine.
  • Day of discectomy: The patient undergoes anterior cervical discectomy and fusion surgery to remove the herniated disc and stabilize the spine. The surgeon may choose a right or left-sided approach based on their preference and the specific anatomy of the patient.
  • After discectomy: The patient may experience temporary hoarseness or difficulty swallowing due to irritation or injury to the recurrent laryngeal nerve during surgery. This is known as recurrent laryngeal nerve palsy (RLNP) and usually resolves within a few weeks to months. The patient undergoes post-operative rehabilitation and physical therapy to regain strength and function in the neck and arms. Follow-up appointments with the surgeon are scheduled to monitor recovery and address any concerns.

What to Ask Your Doctor

  1. What is the likelihood of experiencing recurrent laryngeal nerve palsy (RLNP) following a discectomy procedure?
  2. Are there any specific factors that may increase the risk of RLNP in my case?
  3. How experienced are you in performing discectomy procedures, and what is your success rate in avoiding RLNP?
  4. Can you explain the differences in outcomes between a right-sided and left-sided approach for a discectomy?
  5. What are the potential complications or side effects associated with a discectomy procedure, and how can they be managed?
  6. How long is the recovery process expected to be after a discectomy, and what can I do to aid in my recovery?
  7. Are there any alternative treatment options to consider before proceeding with a discectomy?
  8. What are the long-term effects of a discectomy procedure, and what follow-up care will be needed?
  9. Are there any specific lifestyle changes or precautions I should take after undergoing a discectomy?
  10. What is the likelihood of needing additional surgeries or treatments in the future after a discectomy procedure?

Reference

Authors: Johnson MD, Matur AV, Asghar F, Nasser R, Cheng JS, Prestigiacomo CJ. Journal: World Neurosurg. 2020 Mar;135:135-140. doi: 10.1016/j.wneu.2019.12.052. Epub 2019 Dec 16. PMID: 31857270