A Meta-Analysis of the Incidence of Patient-Reported Dysphagia After Anterior Cervical Decompression and Fusion with the Zero-Profile Implant System

Abstract

Dysphagia is a well-known complication following anterior cervical surgery. It has been reported that the Zero-profile Implant System can decrease the incidence of dysphagia following surgery, however, dysphagia after anterior cervical decompression and fusion (ACDF) with the Zero-profile Implant System remains controversial. Previous studies only focus on small sample sizes. The objective of this study was to determine the incidence of dysphagia after ACDF with the Zero-profile Implant System. Studies were collected from PubMed, EMBASE, the Cochrane library and the China Knowledge Resource Integrated Database using the keywords "Zero-profile OR Zero-p) AND (dysphagia OR [swallowing dysfunction]". The software STATA (Version 13.0) was used for statistical analysis. Statistical heterogeneity across the various trials, a test of publication bias and sensitivity analysis was performed. 30 studies with a total of 1062 patients were included in this meta-analysis. The occurrence of post-operative transient dysphagia ranged from 0 to 76 % whilst the pooled incidence was 15.6 % (95 % CI, 12.6, 18.5 %). 23 studies reported no persistent dysphagia whilst seven studies reported persistent dysphagia ranging from 1 to 7 %). In summary, the present study observed a low incidence of both transient and persistent dysphagia after ACDF using the Zero-profile Implant System. Most of the dysphagia was mild and gradually decreased during the following months. Moderate or severe dysphagia was uncommon. Future randomized controlled multi-center studies and those focusing on the mechanisms of dysphagia and methods to reduce its incidence are required.

Intravenous and local steroid use in the management of dysphagia after anterior cervical spine surgery: a systematic review of prospective randomized controlled trails (RCTs)

“…The anterior approach is commonly used to treat numerous cervical spine pathologies, such as degenerative, traumatic, inflammatory and congenital diseases. Dysphagia following anterior cervical spine surgery (ACSS) is one of the most common complications, with the reported incidence from 1.7 to 88% [1][2][3][4][5][6][7][8][9][10][11][12].…”

Incidence of dysphagia and dysphonia after Hangman's fractures

“…Previous studies have reported the following factors to be associated with higher possibility of dysphagia after anterior cervical surgery: female patients, older patients, C4-5 surgery, anterior plating, long operation time, multi-level surgery, and use of bone morphogenetic protein. [27–29] Theoretically anterior C2-3 surgery was expected to result in a higher incidence of postoperative dysphagia due to the special location and difficult exposure which often requires a much more powerful traction strength during surgery. The Hangman fracture patients often suffered from edema of the esophagus and prevertebral soft tissue which can contribute to the occurrence of dysphagia.…”

Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion

“…Its prevalence following anterior cervical spine surgery ranges from 2% to 60% depending on disease severity and the time frame of assessment. [36] Surgical level, multilevel surgery, female patients, and instrumentation are related to an increased prevalence of postoperative dysphagia, but CDR could significantly reduce postoperative dysphagia compared with ACDF. [37,38] In our meta-analysis, we also found that dysphagia had lower occurrences rate in the CDR group than the ACDF group.…”