title: Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery.
abstract: OBJECTIVE
  The present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors.
  
  
  METHODS
  Patients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital's patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively.
  
  
  RESULTS
  45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (P<0.001). This association was not weakened in multiple logistic regression analysis (OR 2.348, 95% CI 1.467-3.659, P<0.001).
  
  
  CONCLUSIONS
  The incidence of early dysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor.
authors: Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China.
authors: Ji-Huan
authors: JH
authors: Zeng
authors: School of Nursing, Jiangxi Health Vocational College, Nanchang, 330052, China.
authors: Xiao-Dan
authors: XD
authors: Li
authors: Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China.
authors: Liang
authors: L
authors: Deng
authors: Department of Orthopaedics, Jiangxi Province People's Hospital, Nanchang, 330006, China. Electronic address: kyxq168@126.com.
authors: Qiang
authors: Q
authors: Xiao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D055154:Dysphonia / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D055815:Young Adult
keywords: Anterior cervical spine surgery; Early dysphonia; Lower cervical levels