• Anterior cervical discectomy and fusion (ACDF) is a highly effective and safe method for spinal cord and cervical root decompression. Vocal cord paralysis secondary to recurrent laryngeal nerve injury is a common complication after ACDF. The incidence reported as high as 22%. The standard technique for vocal cord evaluation and the most commonly used tool is direct laryngoscopy. Laryngoscopy causes patients annoyance and could potentially contribute to poor patient compliance. Ultrasonography is a non-invasive technique that is used as an alternative tool.

1. Design: A prospective cohort study.
2. Sample size: Assuming that the target population is 240 and positive predictive value of transcutaneous laryngeal ultrasonography is 89.4%. So, the sample size is 91 cases using OPEN Source Epidemiologic Statistics for Public Health (OPENEPI) with confidence interval 95% and power of test is 80%.

All patients underwent transcutaneous laryngeal ultrasonography examination by both anterior and lateral approach of the Vocal Cords (VCs) before the surgery, immediately after extubation, 2 h, 12h, 24 and 48hour postoperatively by an anesthesiologist with an experience of at least three years in ultrasonography scan.

Inclusion Criteria:

• Patient acceptance.
• Both sex
• Age (21-60) years old.
• American Society of Anesthesiologist I / II
• Elective anterior cervical spine surgeries
• patient With Body Mass index (25-35 kg/m²)

Exclusion Criteria:

• Patient refusal.
• Altered mental status.
• Patients with per-existing neurological or thyroid disease affecting vocal cord function.
• Patients with a diagnosis of primary untreated laryngeal/hypopharyngeal cancer.
• Patient with a history of thyroidectomy affecting recurrent laryngeal nerve.
• Patient with a history of laryngeal trauma.
• Pre-operative voice abnormalities.

Egyptian population scheduled for anterior cervical surgeries