Thyroid Obstacle During Anterior Cervical Discectomy and Fusion: When to Call Your ENT Surgeon Fellow? A Scoping Review of Individual Patient Data

Abstract Anterior cervical discectomy and fusion for single-level degenerative disease is a common spine surgery procedure, and thyroid lobectomy is a frequent ENT surgery procedure for symptomatic goiter as well. Exceptionally, a pathological thyroid obstacle may hamper a safe surgical approach to the anterior cervical spine. In such a case, staged surgery or a combined four-hand procedure can both be proposed. This review aims to summarize current knowledge regarding single-staged combined surgery for thyroid disease and cervical spine surgery by the anterior approach. Scoping review on the Medline database from inception to January 2025 concerning combined surgical management of thyroid disease and single-segment cervical spine degenerative disease, illustrated by a case managed in our institution. This review yielded four patients included the present case, with a mean age of 52.5 (±7.9) years old, and a male-to-female sex ratio of 3/1. In 50% (n = 2/4) of the cases, an unexpected prevertebral thyroid obstacle required intraoperative ENT surgeon or general surgeon emergency consultation, whereas four-handed surgery was anticipated in the preoperative setting in 50% of the cases. Combined procedures mainly involved thyroid lobectomy associated with single-segment cervical discectomy and fusion, with an uneventful postoperative course aside from one case of temporary hoarseness. Combined four-hand surgery for prevertebral obstacles during anterior cervical spine surgery for degenerative disc disease seems feasible, both for anticipated or unanticipated thyroid obstacles requiring emergency ENT surgeon consult, as long as the surgical and anaesthesiologist teams are trained accordingly (level of evidence 4). This review requires further clinical validation.