Ultrasound Prediction For Vocal Cord Dysfunction In Patients Scheduled For Anterior Cervical Spine Surgeries

Zagazig University90 enrolled

Overview

• Anterior cervical discectomy and fusion (ACDF) is a highly effective and safe method for spinal cord and cervical root decompression. Vocal cord paralysis secondary to recurrent laryngeal nerve injury is a common complication after ACDF. The incidence reported as high as 22%. The standard technique for vocal cord evaluation and the most commonly used tool is direct laryngoscopy. Laryngoscopy causes patients annoyance and could potentially contribute to poor patient compliance. Ultrasonography is a non-invasive technique that is used as an alternative tool.

1. Design: A prospective cohort study. 2. Sample size: Assuming that the target population is 240 and positive predictive value of transcutaneous laryngeal ultrasonography is 89.4%. So, the sample size is 91 cases using OPEN Source Epidemiologic Statistics for Public Health (OPENEPI) with confidence interval 95% and power of test is 80%. All patients underwent transcutaneous laryngeal ultrasonography examination by both anterior and lateral approach of the Vocal Cords (VCs) before the surgery, immediately after extubation, 2 h, 12h, 24 and 48hour postoperatively by an anesthesiologist with an experience of at least three years in ultrasonography scan.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Vocal Cord Dysfunction

Interventions

Eligibility

Sex: ALLMin age: 21 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patient acceptance. * Both sex * Age (21-60) years old. * American Society of Anesthesiologist I / II * Elective anterior cervical spine surgeries * patient With Body Mass index (25-35 kg/m²) Exclusion Criteria: * Patient refusal. * Altered mental status. * Patients with per-existing neurological or thyroid disease affecting vocal cord function. * Patients with a diagnosis of primary untreated laryngeal/hypopharyngeal cancer. * Patient with a history of thyroidectomy affecting recurrent laryngeal nerve. * Patient with a history of laryngeal trauma. * Pre-operative voice abnormalities.

Outcomes

Primary Outcomes

Predictive performance associated with the postoperative quantitative trans-cutaneous laryngeal ultrasound: conventional middle approach compared to lateral approach

The predictive performance of postoperative vocal cord edema and paralysis using the conventional middle and lateral approach of trans cutaneous laryngeal ultrasound will be evaluated using sensitivity, specificity and accuracy . the gold standard for diagnosis of vocal cord edema and paralysis will be the rigid laryngoscopy

Time frame: at the end of the first 48 hours after the surgery

Secondary Outcomes

Diagnostic performance associated with the postoperative quantitative trans-cutaneous laryngeal ultrasound

The diagnostic performance of postoperative vocal cord paralysis using the trans cutaneous laryngeal ultrasound for diagnosis of recovery of vocal cord paralysis , among subject with vocal cord paralysis

Time frame: At 2 weeks and 3 months after the surgery

The patient discomfort to procedure

The patient discomfort to sonography and rigid laryngoscopy by Discomfort score(Visual analogue scale (VAS)) regarding the amount of discomfort experienced during the procedure. Discomfort was reported by placing a mark on a 10-cm line, with the ends representing "not at all uncomfortable" and "extremely uncomfortable."

Time frame: at the end of first 48 hour postoperative