Characterizing dysphagia after spinal surgery

Abstract

Context/Objective: Dysphagia after spinal surgery is well recognised. Characteristics of post-operative dysphagia are not well defined. This study explored severity, longevity, and physiological characteristics of dysphagia. Design: Prospective, observational study. Setting: Tertiary urban hospital. Participants: Two-hundred fifty patients consecutively receiving spinal surgery.Interventions: Demographic and clinical information were collected. Flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic study of swallowing (VFSS) recordings were analyzed. Outcomes Measures: FEES recordings were analyzed using three validated symptom scales. VFSS recordings were analyzed using 10 objective digital measures of timing, displacement and symptoms. Results: Of 250 patients, 75 were referred for swallowing assessment. Sixty-two received FEES and 11 VFSS. Patients with anterior approach surgery for cervical level injuries represented 85% of referrals (n = 64). Secretion accumulation, aspiration and residue scores decreased significantly within 2 months for most patients. For those with persisting dysphagia, objective VFSS measures demonstrated significant impairments in pharyngeal constriction, hyoid displacement and pharyngoesophageal segment opening with corresponding residue and aspiration scores. By 6 months, all patients had returned to a regular diet except three patients following anterior cervical discectomy and fusion (ACDF) who remained nil by mouth with severe physiological impairments. Conclusions: A quarter of patients following spinal surgery present with dysphagia. For most, symptoms decrease significantly by 2 months and patients return to normal diets. Early screening of dysphagia is critical to avoid secondary complications and prolonged hospitalizations. For some, significant pharyngeal impairments persist and high-quality case series exploring efficacy of rehabilitation programmes are needed.

Characterization of dysphagia following anterior cervical spine surgery

“…We found that patients in the early phase (≤2 months) of recovery exhibited significant structural and physiologic pharyngeal swallowing impairment as well as a higher incidence of bolus airway invasion on VFSS as compared to healthy controls and patients in the late phase of recovery (> 2 months). Our findings agree with previous investigations that have revealed a decrease in dysphagic symptoms within the first two months post-ACSS with most patients able to return to normal diets shortly after (Leonard & Belafsky, 2011;Kang et al, 2011;Miles et al, 2019;Yu & Tao, 2020).…”

“…It has been hypothesized that during the acute recovery phase, the progressive decrease in swelling allows for more complete clearing of the vallecular space and pyriform sinuses, ultimately resulting in resolution of symptoms. However, we found that pharyngeal wall thickness in the late post-operative ACSS group was nearly twice that of controls and this finding is consistent with the literature as well (Muss et al, 2017;Leonard & Belafsky, 2011;Miles et al, 2019;Daggett et al, 2006;Khaki et al, 2013). Since the late group displayed a wide range of days post-surgery (76-1119 days), correlational analysis was completed.…”

“…Another potential limitation of our study was the large range of days following ACSS surgery seen in the late group. The decision to a priori dichotomize the groups at two months was based on previous studies that have utilized similar metrics (Leonard & Belafsky, 2011;Miles et al, 2019). The study was also limited by our sampling method, which selected only for ACSS patients who were referred for VFSS due to subjective complaints of dysphagia.…”

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

“…For the majority, dysphagia after any kind of spinal surgery tends to reduce greatly within 6 months to a year, with most patients returning to their preoperative diets. 22 However, the usual screening of using a return to a patient's baseline diet as a successful outcome may lead to ignoring the possibility of persistent symptoms of dysphagia. The results of this study are not an outlier; multiple studies have also shown a substantial amount of patients with persistent symptoms at 1 year, from rates of 13% to 22%.…”

Interface Fixation Using Absorbable Screws versus Plate Fixation in Anterior Cervical Corpectomy and Fusion for Two-Level Cervical Spondylotic Myelopathy

“…This difference could be explained in 2 aspects. Firstly, tiny esophageal injury or excessive retraction of soft tissue may cause postoperative dysphagia [24]. Plate fixation needs to expose the upper and lower vertebra bodies e921507-5…”