The impact of surgical laterality on recurrent laryngeal nerve palsy in anterior cervical discectomy and fusion: A meta-analysis.

Recurrent laryngeal nerve palsy (RLNP) is a well-recognized complication of anterior cervical discectomy and fusion (ACDF). This meta-analysis aims to evaluate whether the laterality of the surgical approach (right vs. left) influences the incidence of RLNP. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420250650589). MEDLINE, Embase, and Scopus were searched for comparative studies assessing RLNP incidence between right- and left-sided ACDF approaches. Eligible studies included randomized controlled trials, prospective or retrospective cohort studies, and case-control studies. A random-effects model was used to pool odds ratios (ORs), and heterogeneity was explored through sensitivity analyses, subgroup analyses, and meta-regression. Eight studies involving 1,592 patients were included. Of these, 946 underwent right-sided ACDF and 632 underwent left-sided ACDF. Across all studies, 119 cases of RLNP were reported, with 80 (67.2%) occurring after right-sided approaches and 39 (32.8%) after left-sided approaches. The pooled OR for RLNP was 1.74 (95% CI: 0.86-3.52; p = 0.1232), indicating no statistically significant difference between approaches. Moderate heterogeneity was observed (I² = 33%). Sensitivity analyses confirmed the stability of results. Meta-regression identified country of origin as a significant source of heterogeneity (R^2 = 100%) and a significant predictor (p = 0.026). Surgical laterality in ACDF does not appear to significantly influence the risk of RLNP. These findings support that the choice of surgical approach may be guided by surgeon preference and patient-specific anatomical considerations rather than concerns about RLNP risk.