Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

Haller, Leonard; Kharidia, Khush M.; Bertelsen, Caitlin; Wang, Jeffrey; O’Dell, Karla

doi:10.1177/00034894211015582

Cited by 15 publications

(10 citation statements)

References 21 publications

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“…Leonard Haller et al [24] thought that there was inadequate screening and otolaryngology follow-up for patients with Post-operative dysphagia in anterior cervical discectomy and fusion.…”

Section: Discussionmentioning

confidence: 99%

The Role of Prevertebral Soft Tissue Swelling in Dysphagia after Anterior Cervical Corpectomy Fusion: Change Trends and Risk Factors

ma,

Sang,

Chen

et al. 2023

Preprint

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Objectives This study aimed to analyze the change trends of prevertebral soft tissue swelling(PSTS) for anterior cervical corpectomy fusion(ACCF) and to evaluate the risk factors of PSTS for postoperative dysphagia. Methods There were 309 patients with degenerative cervical diseases who were treated with ACCF from November 2015 and September 2019 in our hospital. According to the symptom of swallowing function after ACCF, those were divided into the dysphagia group and the normal-swallowing function group. Cervical CT was analyzed, and radiological evaluation of the prevertebral soft tissue was measured between the anterior surface of each vertebral body and the air shadow of the airway through CT mid-sagittal slice images before operation and after operation(one week, one month, eight months and twelve months). Results The incidence of dysphagia after ACCF was 41.1%. 120 of 127(94.5%) patients had dysphagia disappeared at the 8 months after ACCF, and all disappeared at the 12 months. In both groups, PSTS would be biggest at 1 week postoperatively comparing to the preoperative, and then get smaller from 1 week to 12 months postoperatively (p < 0.05). After 12 months of operation, the PSTS of all cervical spinal levels would get equal to the preoperative size in the normal-swallowing function group, while the PSTS in dysphagia group would get equal only in C5-7. The PSTS of preoperative C6 level and postoperative C2 level were more closely related to the present of postoperative dysphagia (OR: 9.403, 95%CI: 2.344–37.719, OR: 3.187, 95%CI: 1.78–5.705). It was more important in predicting postoperative dysphagia using the value of PSTS at preoperative C6 level and postoperative C2 level, with the cutoff threshold for the PSTS of preoperative C6 level ≦ 1.51cm and postoperative C2 level ≦ 1.3915cm, which could get sensitivity & specificity 66.929% and 61.54%, 77.17% and 64.29%, respectively. Conclusion Our study showed that the increasing of the PSTS after ACCF should be considered as a risk factor of dysphagia after surgery. With the recovery of PSTS over time, the incidence of postoperative dysphagia decreases. The PSTS of preoperative C6 level and and postoperative C2 level should play an important part in predicting the risk of postoperative dysphagia.

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“…Leonard Haller et al [24] thought that there was inadequate screening and otolaryngology follow-up for patients with Post-operative dysphagia in anterior cervical discectomy and fusion.…”

Section: Discussionmentioning

confidence: 99%

The Role of Prevertebral Soft Tissue Swelling in Dysphagia after Anterior Cervical Corpectomy Fusion: Change Trends and Risk Factors

ma,

Sang,

Chen

et al. 2023

Preprint

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“…The EAT-10 [31] also is a strong candidate for universal screening given that it is very quick to administer (10 items) and has proposed cut points for referral for in-depth swallowing evaluation (scores ≥ 3). Early post-operative EAT-10 scores have been shown to predict long-term dysphagia symptoms in ACDF patients [46]. Then, these screening results can yield efficient and accurate referrals for instrumental swallowing assessments which we recognize are costly, time intensive, and require specialized staff and equipment.…”

Section: Recommendations For the Futurementioning

confidence: 99%

A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: the need for a paradigm shift

et al. 2023

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Objective Dysphagia is the most commonly reported complication of annterior cervical discectomy and fusion (ACDF) surgery. However, the incidence of dysphagia post-ACDF varies widely–partly attributable to differing outcome measures used to capture dysphagia. Our objective was to conduct a scoping review of the literature to quantify which dysphagia outcome measures have been employed post-ACDF and examine trends by study design, year, and location. Methods After removing duplicates, 2396 abstracts were screened for inclusion. A total of 480 studies were eligible for full-text review. After applying exclusion criteria, data was extracted from 280 studies. We extracted the dysphagia outcome measure(s), study design (prospective vs retrospective), year, and location (country). Approximately 10% of studies were repeated for intra-rater agreement. Results In total, 317 dysphagia outcome measures were reported in 280 studies (primarily retrospective—63%). The largest proportion of outcome measures were categorized as “unvalidated patient-reported outcome measures” (46%), largely driven by use of the popular Bazaz scale. The next most common categories were “insufficient detail” and “validated patient-reported outcome measures” (both 16%) followed by “chart review/database” (13%) and instrumental assessment (7%). Studies examining dysphagia post-ACDF steadily increased over the years and the use of validated measures increased in the past 10 years. Conclusions This scoping review of the literature highlights that nearly half of the ACDF dysphagia literature relies on unvalidated patient-reported outcome measures. The current understanding of the mechanism, timeline, and presentation of dysphagia post-ACDF are likely limited due to the metrics that are most commonly reported in the literature.

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“…Thus, the timing of evaluation and follow-up influences the rate of diagnosis. Various studies have estimated the rate of dysphagia to range from 1 to 79% [17][18][19][20][21].…”

Section: Figure 1: Study Selection Flowchartmentioning

confidence: 99%

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Tsalimas¹,

Evangelopoulos²,

Benetos³

et al. 2022

Cureus

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Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate.The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: "dysphagia" and "anterior cervical discectomy and fusion" or "ACDF". The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded.Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.

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Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

Cited by 15 publications

References 21 publications

The Role of Prevertebral Soft Tissue Swelling in Dysphagia after Anterior Cervical Corpectomy Fusion: Change Trends and Risk Factors

The Role of Prevertebral Soft Tissue Swelling in Dysphagia after Anterior Cervical Corpectomy Fusion: Change Trends and Risk Factors

A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: the need for a paradigm shift

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

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