Adverse events can frequently occur (14%) during spinal surgery, however, the majority (76.5%) are not associated with complications. Improved patient safety can only be maximized by independent practice audit and the development of prospective methods to record adverse event data so that enhanced, evidence-based, clinical protocols can be developed.

Although previous reports have identified dysphagia as a potential complication of anterior cervical spine surgery (ACSS), current understanding of the nature and etiologies of ACSS-related dysphagia remains limited. The present study was undertaken to describe the patterns of dysphagia that may occur following ACSS. Thirteen patients who exhibited new-onset dysphagia following ACSS were studied retrospectively by means of chart review and videofluoroscopic swallow study analysis. Results indicated that a variety of swallowing impairments occurred following ACSS. In 2 patients, prevertebral soft tissue swelling near the surgical site, deficient posterior pharyngeal wall movement, and impaired upper esophageal sphincter opening were the most salient videofluoroscopic findings. In another 5 patients, the pharyngeal phase of swallowing was absent or very weak, with resulting aspiration in 3 cases. In contrast, an additional 4 patients exhibited deficits primarily of the oral preparatory and oral stages of swallowing including deficient bolus formation and reduced tongue propulsive action. Finally, 2 patients exhibited impaired oral preparatory and oral phases, a weak pharyngeal swallow, as well as prevertebral swelling. Thus, a variety of swallowing deficits, due possibly to neurological and/or soft tissue injuries, may occur following ACSS.

The result of this study demonstrates improved capture of surgical AEs using SAVES. Excellent interobserver reliability between surgeons at different level of training was demonstrated with minimal education or training regarding the use of SAVES.

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An interface to support the collaborative authoring and reuse of commercial multimedia courseware has been designed and prototyped.Task analysis was used to gather initial data. Then rapid prototyping led to the development of an interface which users liked. In response to user reaction each new prototype had fewer options on the screen and greater emphasis on iconic representations.