Soft tissue complications of anterior cervical surgery: Dysphagia, dysphonia, and injuries to the vital nonneural structures of the neck

The anterior approach to the cervical spine is one of the most commonly used procedures in spine surgery. It was first introduced in 1958 by Cloward (10), and Smith and Robinson (70). More recently, osteosynthetic plating has been applied to this technique using specialized systems for retraction, distraction, and fixation, which allow for immediate stabilization of the cervical spine. The anterior approach to the cervical spine provides excellent exposure for resection, reconstruction, and stabilization of the cervical spine for traumatic, degenerative, and neoplastic diseases. However, vital structures can be at risk for injury during an anterior approach to the cervical spine. These include the carotid artery, the vertebral artery, the internal jugular vein, the vagus nerve, the sympathetic plexus, the recurrent laryngeal nerve (RLN), the superior laryngeal nerve (SLN), the trachea, and the esophagus. A detailed knowledge of the surgical anatomy is paramount for avoiding complications (47,60–62). Avoidance of complications is mandatory to ensure excellent clinical results (22,30,78,79,82,87,88,91). The authors review the soft tissue complications of anterior cervical spine surgery and discuss the incidence, diagnosis, management, and operative nuances for preventing these complications.