This retrospective study was designed to determine whether side of approach during instrumented, one- or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC).

Records of all patients who underwent one- or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed. Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of RLN injury diagnosed by OVC after referral for persistent dysphonia. Time from surgery to OVC for patients with right-sided exposures was not statistically different from that for patients with left-sided exposures. Of 418 patients, 278 (66.5%) had right-sided exposures and 140 (33.5%) had left-sided exposures. Eight RLN injuries (1.9%) were noted-five in patients with right-sided exposures (1.8%) and three in patients with left-sided exposures (2.1%). The difference between right- and left-sided injury rates was shown to be nonsignificant using Fisher exact tests.

Results indicate that, given the study's sample size, side of approach during instrumented, one- or two-level primary ACDF has no significant effect on RLN injury incidence in patients with persistent dysphonia referred for OVC. The definitive answer regarding the true incidence of RLN injury relative to approach side awaits a prospective study with preoperative, immediate postoperative, and periodic OVC in a large, homogeneous population with sufficient numbers of patients with right- and left-sided approaches.