Dysphagia rates in single- and multiple-level anterior cervical discectomy and fusion surgery: a meta-analysis

Oh, Lawrence; Ong, Sam; Ghozy, Sherief; Dmytriw, Adam A.; Zuccato, Jeffrey; Mobbs, Ralph J.; Phan, Kevin; Dibas, Mahmoud; Faulkner, Harrison

doi:10.21037/jss-20-506

Cited by 8 publications

(4 citation statements)

References 55 publications

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“…The occurrence of complications of cervical spine surgery usually depends on the surgical procedure, segments of operation, and severity of compression on the spinal cord or nerve root ( 20 ). For example, dysphagia is a common complication of ACDF, while axial pain is prone to occur after the performance of posterior surgical procedures such as LAMP and LF ( 21 , 22 ). In the present study, we found a significantly higher incidence of complications in patients who underwent ACDF compared with those who underwent LAMP and LF, especially for dysphagia and pseudoarthrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Transient dysphagia was one of the most common postoperative complications following the ACDF procedure ( 23 ), a part of which was self-healing, whereas the others may suffer for a long time, severely impacting patients’ living quality. Because the site of operation and fixation with plate and graft were adjacent to the esophagus, patients who underwent the anterior cervical procedure were predisposed to suffer from dysphagia postoperatively, and this tendency was more evident as the operative segments increased ( 21 ). Thus, spinal surgeons need to consider this complication when deciding on their surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

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Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

Wen

Zhong²,

Xu³

et al. 2023

Front. Surg.

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Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2–C7 Cobb angle. Cervical mobility was evaluated using the C2–C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up (P < 0.05), whereas no remarkable difference was found among the groups (P > 0.05). In addition, both C2–7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

Wen

Zhong²,

Xu³

et al. 2023

Front. Surg.

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“…97,98 Multiple levels of ACDF or corpectomies in older individuals can be complicated by dysphagia and swallowing difficulty. [99][100][101][102][103] The most important imaging biological marker of tCSCI is the intramedullary lesion -the product of kinetic energy and molecular cascades immediately following trauma. [104][105][106][107] In vivo MRI studies on intramedullary lesion in rodent models of traumatic SCI have shown neuroprotective effects of hypertonic saline, glibenclamide and S-nitrosoglutathion (GSNO), as evidenced by neurobehavioral improvement and reduced intramedullary lesion size.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Early (≤ 24 Hours), Late (25–72 Hours), and Delayed (>72 Hours) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades C and D Acute Traumatic Central Cord Syndrome Caused by Spinal Stenosis

Aarabi

Akhtar–Danesh

Simard

et al. 2021

Journal of Neurotrauma

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The therapeutic significance of timing of decompression in acute traumatic central cord syndrome (ATCCS) caused by spinal stenosis remains unsettled. We retrospectively examined a homogenous cohort of patients with ATCCS and magnetic resonance imaging (MRI) evidence of post-treatment spinal cord decompression to determine whether timing of decompression played a significant role in American Spinal Injury Association (ASIA) motor score (AMS) 6 months following trauma. We used the t test, analysis of variance, Pearson correlation coefficient, and multiple regression for statistical analysis. During a 19-year period, 101 patients with ATCCS, admission ASIA Impairment Scale (AIS) grades C and D, and an admission AMS of ≤95 were surgically decompressed. Twenty-four of 101 patients had an AIS grade C injury. Eighty-two patients were males, the mean age of patients was 57.9 years, and 69 patients had had a fall. AMS at admission was 68.3 (standard deviation [SD] 23.4); upper extremities (UE) 28.6 (SD 14.7), and lower extremities (LE) 41.0 (SD 12.7). AMS at the latest follow-up was 93.1 (SD 12.8), UE 45.4 (SD 7.6), and LE 47.9 (SD 6.6). Mean number of stenotic segments was 2.8, mean canal compromise was 38.6% (SD 8.7%), and mean intramedullary lesion length (IMLL) was 23 mm (SD 11). Thirty-six of 101 patients had decompression within 24 h, 38 patients had decompression between 25 and 72 h, and 27 patients had decompression >72 h after injury. Demographics, etiology, AMS, AIS grade, morphometry, lesion length, surgical technique, steroid protocol, and follow-up AMS were not statistically different between groups treated at different times. We analyzed the effect size of timing of decompression categorically and in a continuous fashion. There was no significant effect of the timing of decompression on follow-up AMS. Only AMS at admission determined AMS at follow-up (coefficient = 0.31; 95% confidence interval [CI]:0.21; p = 0.001). We conclude that timing of decompression in ATCCS caused by spinal stenosis has little bearing on ultimate AMS at follow-up.

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“…ysphagia after anterior cervical spine surgery is a commonly reported symptom with varying degrees of clinical consequence [1][2][3] . Symptoms are often transient and generally resolve after observation or conservative treatment without substantial impact on patient satisfaction or overall surgical outcomes 1,4 .…”

mentioning

confidence: 99%

Does Operative Level Impact Dysphagia Severity After Anterior Cervical Discectomy and Fusion?

Paziuk,

Mazmudar,

Issa

et al. 2024

Spine

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Study Design: Prospective multi-center cohort study Objective: To explore the association between operative level and postoperative dysphagia after anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Dysphagia is common following ACDF and has several risk factors including soft tissue edema. The degree of prevertebral soft tissue edema varies based upon the operative cervical level. However, the operative level has not been evaluated as a source of postoperative dysphagia. Methods: Adult patients undergoing elective ACDF were prospectively enrolled at three academic centers. Dysphagia was assessed using the Bazaz questionnaire, Dysphagia Short Questionnaire (DSQ), and Eating Assessment Tool-10 (EAT-10) preoperatively and at 2, 6, 12, and 24-weeks postoperatively. Patients were grouped based on inclusion of specific surgical levels in the fusion construct. Multivariable regression analyses were performed evaluating the independent effects of number of surgical levels and inclusion of each particular level on dysphagia symptoms. Results: A total of 130 patients were included. Overall, 24 (18.5%) patients had persistent postoperative dysphagia at 24 weeks and were older, female, and less likely to be drink alcohol. There was no difference in operative duration or dexamethasone administration. Patients with persistent dysphagia were significantly more likely to have C4-C5 included in the fusion construct (62.5% vs. 34.9%, P=0.024) but there were no differences based on inclusion of other levels. On multivariable regression, inclusion of C3-C4 or C6-C7 were associated with more severe EAT-10 (β:9.56, P=0.016 and β:8.15, P=0.040) and DSQ (β:4.44, P=0.023 and (β:4.27, P=0.030) at 6 weeks. At 12-weeks, C3-C4 fusion was also independently associated with more severe dysphagia (EAT-10 β:4.74, P=0.024). Conclusion: The location of prevertebral soft tissue swelling may impact the duration and severity of patient-reported dysphagia outcomes at up to 24 weeks postoperatively. In particular, inclusion of C3-C4 and C4-C5 into the fusion may be associated with dysphagia severity.

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Dysphagia rates in single- and multiple-level anterior cervical discectomy and fusion surgery: a meta-analysis

Cited by 8 publications

References 55 publications

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

Efficacy of Early (≤ 24 Hours), Late (25–72 Hours), and Delayed (>72 Hours) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades C and D Acute Traumatic Central Cord Syndrome Caused by Spinal Stenosis

Does Operative Level Impact Dysphagia Severity After Anterior Cervical Discectomy and Fusion?

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