International and Multicenter Prospective Controlled Study of Dysphagia After Anterior Cervical Spine Surgery

Abstract

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group (P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

An adjustable and stable assistant-free anterior cervical retractor system for microscopy- assisted anterior cervical discectomy and fusion

“…Since its rst report by Robinson and Smith in 1958 [1], anterior cervical discectomy and fusion (ACDF) has proven to be an effective and well-standardized surgical strategy for treating patients with cervical spondylopathy (CS) [2]. Despite its advantages, ACDF may still have surgical complications common to anterior cervical surgery, such as nerve injury [3], esophageal stula [4], dysphagia [5], and carotid artery compression [6]. By tracing the root cause of the aforementioned problems, the application of a retractor was possible [6].…”

Postoperative Measurement of the Retropharyngeal Space Predicts the Risk of Dysphagia After Anterior Cervical Diskectomy and Fusion

“…1,5,6 Several risk factors, including age, female sex, revision surgery, upper cervical spine, multilevel fusion, use of plate instrumentation, surgical time, and intraoperative blood loss, have been reported. 1,2,[7][8][9][10][11][12][13][14][15][16] Prevertebral soft tissue swelling of the retropharyngeal space (RS) has also been proposed as a risk factor. [17][18][19][20][21] However, its clinical significance in the assessment of the risk of postoperative dysphagia remains unclear.…”