Predictors of Dysphagia After Anterior Cervical Discectomy and Fusion

Abstract

Study Design. Multicenter prospective study. Objective. Our aim was to evaluate the incidence and predictors of postoperative dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Dysphagia is a common complication after ACDF that can have significant effect on patients' quality of life, but the frequency of prolonged dysphagia and risk factors are not known. Methods. A multicenter prospective study was undertaken at three academic sites to evaluate patients undergoing ACDF between September 2018 and September 2020. Included patients were aged 18 to 80 years and were undergoing primary or revision ACDF for degenerative spondylosis. Dysphagia was assessed using the validated Eating Assessment Tool (EAT-10) questionnaire, with dysphagia defined as EAT-10 ! 3. Results. A total of 170 patients (53.5% female; mean age at surgery 55.0 yr) were included. At preoperative baseline, 23 patients (13.5%) had dysphagia. Rates of dysphagia increased to 45.3% at 2 weeks postoperatively but gradually decreased to 15.3% at 24 weeks. On univariate analysis, patients with dysphagia at 2 weeks had longer operations (113.1 AE 58.4 vs. 89.0 AE 39.8 minutes, P ¼ 0.003) and higher baseline dysphagia rates (18.2% vs. 6.2%, P ¼ 0.018) and were more likely to be female (66.2% vs. 45.7%, P ¼ 0.009). Patients with prolonged dysphagia had more levels fused (2.1 AE 1.0 vs. 1.7 AE 0.7, P ¼ 0.020), longer operations (131.8 AE 63.1 vs. 89.3 AE 44.3 minutes, P < 0.001), and higher baseline dysphagia rates (32% vs. 7.1%, P < 0.001) and were more likely to be smokers (24% vs. 8%, P ¼ 0.021). On multivariate analysis to determine associations with prolonged dysphagia, only smoking status (OR 6.2, 95% CI 1.57-24.5, P ¼ 0.009) and baseline dysphagia (OR 5.1, 95% CI 1.47-17.6, P ¼ 0.01) remained significant. Conclusion. Dysphagia is common immediately after ACDF, but rates of prolonged dysphagia are similar to preoperative baseline rates. We identified dysphagia rates over time and several patient factors associated with development of short-and long-term postoperative dysphagia.

Facet Distraction and Dysphagia: A Prospective Evaluation of This Common Postoperative Issue Following Anterior Cervical Spine Surgery

“…The EAT-10 questionnaire asks patients to rate difficulty in 10 swallowing activities on a 0 to 4 scale, for a total score out of 40. The EAT-10 performs with high internal validity and may capture dysphagia following ACDF more accurately than the Bazaz survey 27…”

“…The EAT-10 performs with high internal validity and may capture dysphagia following ACDF more accurately than the Bazaz survey. 27…”

Early Voice and Swallowing Disturbance Incidence and Risk Factors After Revision Anterior Cervical Discectomy and Fusion Using a Multidisciplinary Surgical Approach: A Retrospective Cohort Evaluation of a Prospective Database

“…Our incidence rates of dysphagia fall within the ranges of prior estimates ranging from 1.7% to 67%. 11,[28][29][30][31][32][33] One study conducted by Smith-Hammond et al 34 used a similar functional measurement assessment of swallowing and reported a 47% incidence of abnormality on videofluoroscopic assessment 1 week 35 However, they only report 14 of the 170 patients to be reoperative ACDFs. Our study population is entirely representative of reoperative cases.…”

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

“…Individuals who undergo surgery for cervical spine disease with anterior or posterior access tend to develop oropharyngeal dysphagia, which is often severe during the first month and progressively diminishes in intensity over time [26]. Multivariable analyses have identified smoking status, prior cervical surgery, preoperative C2-C7 angle, preoperative dysphagia, preoperative chronic obstructive pulmonary disease, multilevel surgery, and intraoperative steroid use as significant risk factors for dysphagia after ACDF [26][27][28][29][30]. However, the prospective study by Opsenak et al failed to confirm these findings [31].…”