Incidence of dysphagia comparing cervical arthroplasty and ACDF

Abstract

Study designRetrospective cohort from randomized prospective clinical trial.ObjectiveEvaluate incidence of dysphagia between instrumented ACDF and a no-profile cervical disc arthroplasty.Summary of background dataDysphagia is a well-known complication following anterior cervical discectomy and fusion (ACDF) and the etiology is multifactorial. One potential source for postoperative dysphagia involves the anterior profile of the implant used. Hence, a no-profile cervical disc arthroplasty could theoretically have fewer soft tissue adhesions and a lower incidence of dysphagia. The purpose of this study is to compare the incidence of dysphagia at least 1 year postoperatively following ACDF with anterior plating and a no-profile cervical disc arthroplasty.MethodsA cohort of 87 patients meeting the inclusion criteria for the prospective, randomized, multicenter IDE trial of ProDisc-C versus ACDF were evaluated for dysphagia. Forty-five patients were randomized to receive cervical arthroplasty and 42 patients were randomized to the ACDF and plate group. The Bazaz-Yoo dysphagia questionnaire was administered in a blinded fashion after completion of at least 12 months follow-up.ResultsFollow-up averaged 18.2 months and included 76 (87%) of the 87 enrolled, with 38 of the original 45 in the arthroplasty group and 38 of the original 42 in the ACDF group. Six of 38 (15.8%) in the arthroplasty group versus 16 of 38 (42.1%) in the ACDF group reported ongoing dysphagia complaints. This was found to be statistically significant (P = .03).ConclusionThis study suggests a significantly lower rate of dysphagia with a no-profile cervical disc arthroplasty compared to instrumented ACDF for single level disc disease between C3-7. Though there are many potential etiologies, we hypothesize this is related to the lack of anterior hardware in the retropharyngeal space. Operative technique, operating time, and significant midline retraction did not seem to result in more dysphagia complaints. Future studies comparing cervical disc arthroplasty and no-profile fusion devices may help delineate the effect that anterior instrumentation profile has on postoperative dysphagia.

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

“…Furthermore, it has been hypothesized that the decrease in motion caused by ACDF can lead to the formation of more scar tissue than that caused by CDR and also can potentially contribute to swallowing difficulty. 27 In line with this hypothesis, it has been suggested that dysphagia increases the risk of aspiration and pneumonia. 4 Nonetheless, the higher morbidity rate after ACDF is most likely multifactorial and cannot be attributable to the subtle differences in the respective procedures alone.…”

“…22 We have noticed that a number of patients who undergo extension during ACDF complain of postoperative muscle spasms that generally subside within 6-8 weeks. Second, the instrumentation techniques used in ACDF need to be considered; the use of plates in ACDF has been linked to the development of dysphagia, 27 which was the cause of readmission for several patients who underwent this procedure in our study. Furthermore, it has been hypothesized that the decrease in motion caused by ACDF can lead to the formation of more scar tissue than that caused by CDR and also can potentially contribute to swallowing difficulty.…”

Does cervical disc arthroplasty have lower incidence of dysphagia than anterior cervical discectomy and fusion? A meta-analysis

“…The full text was assessed in the remaining 53 studies for eligibility criteria. Eventually, 10 published RCTs were included in the meta-analysis [11][12][13][17][18][19][20][21][22][23].…”

“…The CDA group received disc prosthesis and the ACDF group underwent interbody fusion with plate fixation. Eight of 10 studies were conducted in the United States and were multicenter FDA-regulated investigational device exemption pivotal trials [11][12][13]17,[19][20][21]23], and other studies were conducted in China [18] and Sweden [22]. Only 4 of 10 studies described the evaluation methods of dysphagia, including the Bazaz Dysphagia Score [11,12], Functional Outcome Swallowing Scale (FOSS) [21] and DSQ [22].…”

“…Meanwhile, the incidence of dysphagia following these two different procedures has been attracting the attention of the researchers. McAfee et al [11] and Segebarth et al [12] specifically examined dysphagia events and reported a significantly lower incidence of dysphagia after CDA than after ACDF. In contrast, Anderson et al [13] found that dysphagia was more frequent in the CDA group than in the ACDF group.…”