Outcomes after anterior spine surgeries are mostly satisfactory, with an extremely low mortality rate. However, there are inherent morbidities, perhaps the most notable of these is injury to the recurrent laryngeal nerve, which can significantly influence patients' quality of life. One method to potentially reduce this is the use of intraoperative monitoring of the recurrent laryngeal nerve during surgery. The central goal of this study is to determine the effectiveness of recurrent laryngeal nerve intraoperative monitoring to reduce the risk of adverse voice outcomes following anterior cervical spine surgeries. Patients will undergo routine ACDF surgery by MUSC spine surgeons, with use of intraoperative neuro-monitoring of the recurrent laryngeal nerve via EMG endotracheal tube. Pre-operative and post-operative swallowing, voice, and overall quality of life standardized questionnaires will be administered, and outcomes evaluated and analyzed.