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Weakness is deltoid
4%
42/1105
Weakness in biceps
2%
21/1105
Vocal cord paresis
78%
866/1105
Miosis and ptosis of the eyelid
15%
167/1105
Weakness of the platysma
1%
6/1105
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Prolonged retraction against the tracheoesophageal junction poses an increased risk for recurrent laryngeal nerve injury. Cervical myelopathy results from chronic spinal cord compression by bulging discs, buckled ligamentum flavum, and osteophytes. Single-level disease with cervical kyphosis >10° is a strong indication to treat with an anterior cervical discectomy and fusion (ACDF). However, the anterior approach to the cervical spine is associated with unique complications such as recurrent laryngeal nerve palsy, which manifests as hoarseness, dysphagia, and an increased risk of aspiration. Vigorous retraction against the tracheoesophageal junction and excessive endotracheal tube inflation are risk factors for the development of this complication. Ebraheim et al. performed a cadaveric study with 15 specimens determining the vulnerability of the recurrent laryngeal nerve with the anterior approach to the cervical spine. They reported that the recurrent laryngeal nerve lies deep within the tracheoesophageal groove on the left and 6.5 mm anterior and 7.3 mm lateral to the groove on the right. The authors concluded that the recurrent laryngeal nerve is susceptible to injury if prolonged retraction of the midline structures occurs, especially on the right side. Kilburg et al. performed a retrospective study of 418 patients that underwent a one- to two-level ACDF to determine the effect of approach side on recurrent laryngeal nerve injuries. The authors reported a 1.8% rate of injury with right-sided approaches and a 2.1% rate of injury with left-sided approaches. They concluded that no association was found regarding the laterality and risk of recurrent laryngeal nerve injury. Incorrect answers: Answers 1 and 2: C5 and C6 radiculopathy would result in deltoid and biceps weakness. These corresponding nerve roots, however, are not at risk with an anterior approach to the cervical spine. Answer 4: Horner's syndrome manifests with miosis and ptosis of the eyelid resulting from injury to the sympathetic trunk. This can be associated with excessive lateral reaction against the longus colli muscles. Answer 5: The platysma is innervated by cranial nerve VII, which is not directly at risk during the standard anterior approach to the cervical spine.
4.8
(4)
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