Feasibility and prognostic utility of laryngeal adductor reflex monitoring in anterior cervical spine surgery

IF 3.4 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology Pub Date : 2026-01-01 Epub Date: 2025-11-08 DOI:10.1016/j.clinph.2025.2111430

Jongsuk Choi , Ki Eob Kim , Min Jun Song , Joo Hyeong Lee , Byung Hoon Yoon , Kyung Seok Park

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引用次数: 0

Abstract

Objective

To evaluate the feasibility and clinical relevance of intraoperative laryngeal adductor reflex (LAR) monitoring for detecting recurrent laryngeal nerve (RLN) dysfunction during anterior cervical discectomy and fusion (ACDF).

Methods

LAR monitoring was performed in 104 patients undergoing ACDF using an electromyographic endotracheal tube. R1 amplitudes were recorded, and significant reductions were classified as transient or permanent. Swallowing and voice outcomes were assessed on postoperative day 7 (POD7), and at 3 and 6 months (POM3, POM6). Receiver operating characteristic (ROC) analysis was used to identify amplitude-reduction thresholds associated with RLN dysfunction.

Results

LAR signals were successfully obtained in 89.4 % of patients. Transient amplitude reductions occurred in 55 patients and were associated with short-term symptoms at POD7 (sensitivity 100 %, specificity 46.6 %, area under the curve [AUC] = 0.88), which resolved by POM6. Permanent reductions (n = 4) corresponded to persistent RLN dysfunction, with 100 % specificity and positive predictive value. Sensitivity increased over time, reaching 100 % at POM6. Post hoc ROC analysis identified an 81 % amplitude-reduction threshold that accurately predicted persistent RLN dysfunction at final follow-up (AUC = 1.000).

Conclusions

Intraoperative LAR monitoring was feasible and demonstrated strong predictive value for RLN dysfunction during ACDF.

Significance

LAR monitoring may enhance intraoperative neurophysiological monitoring by enabling real-time assessment of vagus nerve function in cervical spine surgery.

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喉内收肌反射监测在颈椎前路手术中的可行性及预后价值

目的评价术中喉内收反射（LAR）监测在颈前椎间盘切除术融合术（ACDF）中检测喉返神经（RLN）功能障碍的可行性及临床意义。方法采用肌电图气管内管对104例ACDF患者进行slar监测。R1振幅被记录下来，显著的减少被分类为短暂或永久的。在术后第7天（POD7）、第3个月和第6个月（POM3、POM6）评估吞咽和语音结果。受试者工作特征（ROC）分析用于识别与RLN功能障碍相关的降幅阈值。结果89.4%的患者成功获得slar信号。55例患者出现短暂的波幅降低，并伴有短期症状（敏感性100%，特异性46.6%，曲线下面积[AUC] = 0.88），经POM6缓解。永久性减少（n = 4）对应于持续性RLN功能障碍，具有100%的特异性和阳性预测值。灵敏度随时间增加，在POM6时达到100%。事后ROC分析发现81%的幅度降低阈值可以准确预测最终随访时持续的RLN功能障碍（AUC = 1.000）。结论术中LAR监测是可行的，对ACDF中RLN功能障碍具有较强的预测价值。通过实时评估颈椎手术中迷走神经功能，ar监测可增强术中神经生理监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurophysiology 医学-临床神经学

CiteScore

8.70

自引率

6.40%

发文量

932

审稿时长

59 days

期刊介绍： As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.