• Anterior cervical spine surgery;
  • voice;
  • Level of Evidence: 4



Dysphonia is a common postoperative complaint following anterior cervical spine surgery (ACSS). The purpose of this study was to analyze voice outcomes following ACSS, to identify risk factors predicting vocal cord impairment, and to develop an algorithm for postoperative management of dysphonic patients.

Study Design:

Retrospective cohort study.


This was a retrospective review of 815 consecutive patients undergoing ACSS from January 2000 to January 2009. All cases were performed using a team approach with a neurosurgeon and head and neck surgeon. Factors associated with voice change and vocal cord motion impairment were analyzed.


The mean age of the cohort was 53 years (range, 13–88 years), with a male-to-female ratio of 1.2. There were 32 of 815 available patients (3.9%) who developed dysphonia following ACSS. Fiberoptic laryngoscopy demonstrated that only nine (1.1%) of these patients had ipsilateral vocal fold motion impairment. Of these nine patients, only one (0.1%) was found to have permanent vocal fold paralysis at 1-year follow-up. Factors that correlated significantly with voice change included kyphosis, revision surgery, and level C6-C7 surgery. Kyphosis was the only independent factor correlating with voice change.


ACSS is a safe surgical procedure with a low incidence of postoperative dysphonia when exposure is provided by a head and neck surgeon. Team performance of ACSS appears to reduce laryngeal complications and optimize the management of temporary or permanent postoperative dysphonia.