Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Feb 9;17(2):e78763.
doi: 10.7759/cureus.78763. eCollection 2025 Feb.

Incidence, Risk Factors, and Outcomes of Recurrent Laryngeal Nerve Injury and Dysphonia Following Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis

Adam A Abu-Gameh  1 , Jonathan E J Koch  2 , David Schleifer  2 , Yuval Baruch  2 , Itzhak Engel  2 , Eyal Yaacobi  2 , Nissim Ohana  2
Affiliations
Review

Incidence, Risk Factors, and Outcomes of Recurrent Laryngeal Nerve Injury and Dysphonia Following Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis

Adam A Abu-Gameh et al. Cureus. .

Abstract

Anterior cervical spine surgery (ACSS) is an effective treatment for various cervical spine conditions but carries a risk of recurrent laryngeal nerve (RLN) injury and dysphonia. This systematic review and meta-analysis aimed to evaluate the incidence of these complications and their associated risk factors. An analysis of 17 studies involving 5,706 patients revealed a pooled RLN injury incidence of 3.41% and a dysphonia incidence of 2.5%. Prolonged surgeries exceeding two hours and multilevel procedures were associated with higher risks, while implant material demonstrated minimal impact. These findings highlight the importance of surgical planning to mitigate RLN injury risk and improve patient outcomes in ACSS.

Keywords: anterior cervical spine surgery; dysphonia; implant materials; recurrent laryngeal nerve injury; surgical risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram outlining the systematic review process
PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses
Figure 2
Figure 2. Forest plot illustrating the pooled incidence of RLN injury across studies
RLN, recurrent laryngeal nerve
Figure 3
Figure 3. Simplified cumulative meta-analysis plot showing the progression of cumulative ORs as more studies are included over time
Figure 4
Figure 4. Risk of bias assessment for each included study, color-coded by risk level (low, moderate, and high) across selection, performance, detection, attrition, and reporting biases
Figure 5
Figure 5. Funnel plot assessing publication bias across the included studies
See this image and copyright information in PMC

References

    1. What's new in spine surgery. Bridwell KH, Anderson PA, Boden SD, Vaccaro AR, Wang JC. J Bone Joint Surg Am. 2009;91:1822–1834. - PubMed
    1. Recurrent laryngeal nerve palsy after cervical spine surgery: a multicenter AOSpine clinical research network study. Gokaslan ZL, Bydon M, De la Garza-Ramos R, et al. Global Spine J. 2017;7:53–57. - PMC - PubMed
    1. Recurrent laryngeal nerve injury after thyroid surgery: an analysis of 11,370 patients. Gunn A, Oyekunle T, Stang M, Kazaure H, Scheri R. J Surg Res. 2020;255:42–49. - PubMed
    1. The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps. Ducic I, Mesbahi AN, Attinger CE, Graw K. Plast Reconstr Surg. 2008;121:908–914. - PubMed
    1. Recurrent laryngeal nerve palsy after anterior cervical spine surgery: the impact of endotracheal tube cuff deflation, reinflation, and pressure adjustment. Audu P, Artz G, Scheid S, et al. Anesthesiology. 2006;105:898–901. - PubMed

LinkOut - more resources