Dysphagia After Anterior Cervical Spine Surgery: Incidence and Risk Factors

Kalb, Samuel; Reis, Marco T.; Cowperthwaite, Matthew C.; Fox, Douglas J.; Lefevre, Richard D; Theodore, Nicholas; Papadopoulos, Stephen M.; Sonntag, Volker K. H.

doi:10.1016/j.wneu.2011.07.004

Cited by 118 publications

(121 citation statements)

References 18 publications

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“…This finding was statistically significant (p = 0.05). 12 Bazaz et al reported a similar finding of increased age in their RLN injury group, 53 years in their patients with postoperative RLN palsies compared with 50 years for those treated with ACDF without RLN palsy; their age differences were not statistically significant. Lastly, the means of data collection to determine RLN palsy was a potential confounder, as potential palsies were not consistently assessed across patients in the studies.…”

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confidence: 73%

“…Kalb et al reported in their 2012 study that ACDF at C4-5 and C5-6 levels were most often associated with dysphagia, with rates of 67% and 81%, respectively. 12 These rates were significantly higher than rates of RLN palsy after ACDF procedures performed at higher levels of the cervical spine. 12 A study by Apfelbaum et al revealed similar findings of increased RLN paresis with dysphagia at lower ACDF levels.…”

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confidence: 83%

“…12 These rates were significantly higher than rates of RLN palsy after ACDF procedures performed at higher levels of the cervical spine. 12 A study by Apfelbaum et al revealed similar findings of increased RLN paresis with dysphagia at lower ACDF levels. The authors proposed that this was secondary to larger endotracheal deflection and a greater potential stretch on the RLN when operating lower in the cervical spine.…”

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confidence: 83%

“…4 Older studies have suggested that the anatomical course differences between the left and right RLN may impact RLN The timing of assessment of RLN injury varied widely in the studies. Kalb et al 12 looked at RLN injuries between 6 weeks and 1 year, with a 6-month mean. Lee et al…”

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confidence: 99%

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Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Erwood¹,

Hadley²,

Gordon³

et al. 2016

SPI

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OBJECTIVE Recurrent laryngeal nerve (RLN) injury is one of the most frequent complications of anterior cervical discectomy and fusion (ACDF) procedures. The frequency of RLN is reported as 1%–11% in the literature.4,15 The rate of palsy after reoperative ACDF surgery is not well defined. This meta-analysis was performed to review the current medical evidence on RLN injury after ACDF surgery and to determine a relative rate of RLN injury after reoperative ACDF. METHODS MEDLINE, PubMed, and Google Scholar searches were performed using several key words and phrases related to ACDF surgery. Included studies were written in English, addressed revisionary ACDF surgery, and studied outcomes of RLN injury. Statistical analysis was then performed using a random-effects model to calculate a pooled rate of RLN injury. The heterogeneity of the studies was assessed using Cochran's Q statistic and I2 statistic, and a funnel plot was constructed to evaluate publication bias. RESULTS The search initially identified 345 articles on this topic. Eight clinical articles that met all inclusion criteria were included in the meta-analysis. A total of 238 patients were found to have undergone reoperative ACDF. Thirty-three of those patients experienced an RLN injury. This analysis identified a rate of RLN injury in the literature after reoperative ACDF of 14.1% (95% confidence interval [CI] 9.8%–19.1%). CONCLUSIONS The rate of RLN palsy of 14.1% was greater than any published rate of RLN injury after primary ACDF operations, suggesting that there is a greater risk of hoarseness and dysphagia with reoperative ACDF surgeries than with primary procedures as reported in these studies.

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confidence: 73%

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confidence: 83%

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confidence: 83%

mentioning

confidence: 99%

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Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Erwood¹,

Hadley²,

Gordon³

et al. 2016

SPI

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“…In all our cases, dysphagia was transient and required no special treatment. Although most studies reported that dysphagia decreases with time, the prevalence of chronic dysphagia is more common than previously considered (73,(78)(79)(80).…”

Section: Dysphagiamentioning

confidence: 84%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Characterizing Long‐Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach

Toure,

Abend,

Lipsky

et al. 2024

The Laryngoscope

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Objectives(1) Assess the frequency and severity of long‐term swallowing and voice complaints, follow‐up care, risk factors for the development of long‐term swallowing and voice complications in patients who underwent anterior transcervical approach (ACA). (2) Determine incidence of long‐term swallowing and voice complications requiring follow‐up otolaryngologic care and assess the frequency of otolaryngologic follow‐up for postoperative swallowing and voice complaints.MethodsRetrospective cohort study of patients between January 2017 and March 2020 who underwent ACA. Demographic information, data from preoperative evaluation, operative records, and data from postoperative visits were collected. Patients were contacted to complete the Eating Assessment Tool and the “Impairment” subset of the Voice Symptoms Scale.ResultsA total of 48 patients (10.6%) followed up with a head and neck surgeon for swallowing complaints and 31 patients (6.8%) for voice complaints. Otolaryngology follow‐up for swallowing complaints among patients with at least 3 and 12 months of follow‐up was 16.4% and 17.8%, respectively. Otolaryngology follow‐up for voice complaints among patients with at least 3 and 12 months of follow‐up was 11.7% and 11.9%, respectively. Swallowing function was abnormal in 40.7% at least 3 months after surgery and in 41.8% 12 months after. Voice function was abnormal in 55.7% of respondents at least 3 months after surgery and in 54.5% of respondents 12 months after.ConclusionsACA is associated with otolaryngologic complications that include dysphagia and dysphonia. This study demonstrates that long‐term swallowing and voice dysfunction appear to persist longer than what is noted by patient utilization of follow‐up otolaryngologic care.Level of EvidenceIV Laryngoscope, 2024

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Dysphagia After Anterior Cervical Spine Surgery: Incidence and Risk Factors

Cited by 118 publications

References 18 publications

Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Characterizing Long‐Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach

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