A Prospective Cohort Study of Dysphagia After Subaxial Cervical Spine Surgery

Abstract

Study Design. Prospective observational cohort study. Objective. To prospectively examine dysphagia after subaxial cervical spine surgery. Summary of Background Data. Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery. Methods. This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined. Results. Thirty-two patients (16.8%) reported dysphagia before surgery. New dysphagia after surgery, defined as more than or equal to 1 grade worsening of the Bazaz score after surgery compared with the preoperative status, was observed in 38 patients (19.9%) at 6 months and 32 patients (16.8%) at 1 year. The incidence of new dysphagia at 1 year was 25.3% in the ADF group, 23.8% in the PDF group, and 6.0% in the LAMP group. Fusion surgery (ACDF or PDF) and increased CL after surgery were found as risk factors at 1 year in multivariate analysis; receiver operating characteristic analysis determined a postsurgical change in CL cutoff of 58. Conclusion. Fusion surgery and increased CL after surgery were risk factors for development of dysphagia after subaxial cervical spine surgery. Cervical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.

Impact of Frailty and Cervical Radiographic Parameters on Postoperative Dysphagia Following Anterior Cervical Spine Surgery

“…The relationship between postoperative dysphagia and sub-axial cervical alignment has not been well investigated. 30,31 Previous research has suggested that an increase in the C2-C7 angle exceeding 5°is associated with a higher risk of postoperative dysphagia. 15,30,32,33 In this study, we observed that the dysphagia group had a mean increase in C2-C7 angle of 6.4 9.7°.…”

Ultrasound-guided Cervical Retro-laminar Block for Cervical Radicular Pain: A Comparative Analysis

“…The anatomical targets of these blocks are the transverse process and its overlaying muscles and interfascial plane. [6][7][8][9][10][11][12][13][14][15][16][17] The cervical transverse process is significantly smaller than the thoracolumbar ones, and the vertebral artery runs in the vertebral canal in proximity to the cervical transverse process. This structure poses a challenge in localizing the needle and increases the risk of vascular injury.…”

“…Other ultrasound-guided cervical erector spinae plane (ESP) blocks have been reported for the treatment of cervical postsurgical pain. The anatomical targets of these blocks are the transverse process and its overlaying muscles and interfascial plane 6–17. The cervical transverse process is significantly smaller than the thoracolumbar ones, and the vertebral artery runs in the vertebral canal in proximity to the cervical transverse process.…”

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study

“…For the evaluation of functional status, Japanese Orthopedic Association (JOA), Neck Disability Index (NDI) ( 12 ), and the neck Visual Analogue Scale (VAS) pain scores were used. The prevalence of dysphagia was determined by utilizing the Bazaz system ( Table 1 ) ( 13 ).…”