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Neck News

Right or Left? Neck Surgeons Don't Have to Choose Sides

When operating on the spine through the front of the neck, surgeons have to decide whether to make the incision on the right or left side of the neck. It used to be that they went in through the left to avoid hurting the recurrent laryngeal nerve, or RLN.

The RLN hooks up with the voice box (larynx). The nerve takes a windier path getting there on the right side of the neck. Some doctors think this puts the nerve at risk for injury when surgery is done through the right side. Damage to this nerve can cause hoarseness or even loss of speech if the vocal cord is paralyzed.

To determine whether surgery on the right or left side was more likely to lead to RLN injury, the authors examined the cases of 328 patients who had surgery to fuse the spine through the front of their necks. One hundred eighty-six of the patients were men; 142 were women. Their ages ranged from 7 to 82 years old. Four different surgeons performed the operations. One hundred seventy-three surgeries were from the right; 155 were from the left.

Patients were said to have RLN injury if they had hoarseness lasting at least two weeks after surgery. Out of 328 patients, nine (2.9 percent) had RLN injuries. Seven patients' symptoms went away within three months. The other two patients had ongoing symptoms that were identified as vocal cord paralysis. These two patients had been operated on from the left.

Overall, though, whether the surgery was on the right or left side didn't make much difference for RLN injuries. The percentage of patients with injuries was 2.3 percent for those operated on from the right and 3.2 percent for those operated on from the left. In other words, the level of risk was nearly the same for both sides.

Patients' chance of RLN injury didn't depend on the type of procedure they had or whether special medical instruments were used. Chances of RLN injury didn't change if patients were having more than two discs fused. However, patients who were on their second operation of this type were more prone to RLN injury than those who hadn't had this kind of procedure before. For patients having their second surgery, the risk of RLN injury rose to 9.5 percent.

In general, this study suggests that surgeons can safely operate from whichever side of the neck they choose. In the case of repeat surgeries, surgeons should make their choice based on a thorough patient evaluation to reduce risk of injury.


William J. Beutler, MD, et al. Recurrent Laryngeal Nerve Injury With Anterior Cervical Spine Surgery. In Spine. June 15, 2001. Vol. 26. No. 12. Pp. 1337-1342.



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