Swallowing Function Following Anterior Cervical Discectomy and Fusion With and Without Anterior Plating: A SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment

Abstract

ObjectiveAnterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. This study aims to quantify the effect of anterior plating on swallowing-quality of life (SWAL-QOL) scores and radiographic swelling assessments following a primary, single-level ACDF. MethodsPatients retrospectively reviewed. Patients grouped into those receiving a cage or anterior plate. SWAL-QOL scores were recorded preoperatively and 6 weeks and 12 weeks postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anterior-posterior diameter of each involved vertebral body. An air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. ResultsSixty-eight primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between Cage and Plate cohorts. Finally, no differences were observed in postoperative SWAL-QOL scores or swelling and air indices between groups. ConclusionThe results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable.

Surgical Treatment of Dysphagia Secondary to Anterior Cervical Osteophytes Due to Diffuse Idiopathic Skeletal Hyperostosis

“…Although Miyamoto et al reported recurrent osteophyte formation in all seven patients and revision surgery in two, Mattioli et al reported that only 1 of 21 patients experienced asymptomatic recurrence at 9 years after surgery [ 1 , 27 ]. Anterior plate fixation, some argue, may cause additional esophageal compression, while others claim that the plate itself is not relevant to swallowing difficulty and could act as a physical barrier and suppress bony overgrowth [ 28 , 29 ]. Chung et al reported that simple osteophytectomy alone tended to yield more favorable results than additional plate fixation on the Dysphagia Outcome and Severity Scale [ 11 ].…”

Dysphagia May Attenuate Improvements in Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

“…13 The questionnaire is among the few dysphagia evaluation tools which has demonstrated correlation with severity of swallowing difficulty in patients with cervical spine deformity or degenerative pathology. 20,[25][26][27] While this tool effectively evaluates and quantifies dysphagia, its relationship with other PROMs is less established. In addition, the clinical implications of swallowing difficulty with respect to its effect on other areas of a patient's postoperative recovery have largely remained underreported in the spine surgery literature.…”

Surgical Outcomes of Dysphagia Provoked by Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine

“…Some, including the present authors, consider that screw and plate fixation can cause additional esophageal compression, 28 while others argue that a plate itself is not relevant to swallowing difficulties. 29 Theoretically, a plate and screws would occupy space and contribute to PVST narrowing; however , it may also act as a physical barrier and suppress bony overgrowth. It is not certain that fixation surgery with a plate is superior or inferior to simple osteophytectomy in DISH-phagia.…”