Risk Factors for Dysphagia After Anterior Cervical Spine Surgery

Abstract

This study evaluated the risk factors for dysphagia after anterior cervical spine surgery by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. The patients underwent anterior cervical spine surgery and were followed for at least 6 months. Sex, age, tracheal mobility, smoking history, implant type, C3 anterior vertebral soft tissue swelling, narrowest esophageal distance before internal fixation, cervical curvature, operative time, occurrence of fusion, number of operative segments, and highest vertebral segment were recorded. Chi-square test and logistic regression were performed to analyze the predictive value of each dimension for dysphagia. A total of 158 patients were included in this study. The mean C3 anterior vertebral soft tissue swelling was 8.8±4.5 mm, the mean narrowest esophageal distance before internal fixation was 6.9±4.4 mm, and the mean operative time was 78.5±39.2 minutes. Chi-square test results showed that age 60 years and older, female sex, internal fixation with titanium plate/titanium mesh, narrowest esophageal distance before internal fixation of less than 5 mm, and 3 operative segments indicated a relatively high incidence of dysphagia. Logistic regression analyses showed that age, sex, implant type, narrowest esophageal distance before internal fixation, and number of operative segments were all risk factors predictive of postoperative dysphagia. The area under the receiver operating characteristic curve was 0.872. Age 60 years and older, female sex, internal fixation with titanium plate/titanium mesh, narrowest esophageal distance before internal fixation of less than 5 mm, and 3 operative segments were risk factors for dysphagia after anterior cervical surgery. The regression equation may be used to predict the occurrence of dysphagia. [Orthopedics. 2018; 41(1):e110-e116.].

Comparison of Complications between Anterior Cervical Diskectomy and Fusion versus Anterior Cervical Corpectomy and Fusion in Two- and Three-Level Cervical Spondylotic Myelopathy: A Meta-analysis

“…The incidence of dysphagia after anterior cervical spine surgery has been reported as ranging from 1 to 80%. 40 41 In our study, 50 (6.8%) of the 738 patients experienced dysphagia after anterior cervical surgery. It was suggested that the pressure applied by the retractor blade on the pharynx/esophagus complex can lead to local ischemia, followed by subsequent reperfusion and edema formation, which can result in early postoperative dysphagia.…”

“…It was suggested that the pressure applied by the retractor blade on the pharynx/esophagus complex can lead to local ischemia, followed by subsequent reperfusion and edema formation, which can result in early postoperative dysphagia. 42 In Li's 40 study, the number of female patients with dysphagia after anterior cervical spine surgery was significantly higher than the number of male patients (46.4 vs. 17.6%). It may be related to the smaller average neck circumference and weaker muscles and soft tissues of females.…”

Novel Tape Suture Osteosynthesis for Hyperextension Injuries of the Subaxial Cervical Spine: A Biomechanical Study

“…However, there are numerous complications associated with a ventral cervical spondylodesis, such as plate malpositioning with consequent soft tissue or nerve root irritation as well as screw loosening resulting in nonunion (8). The postoperative swelling due to the extensive surgical invasiveness and the relevant size of the implants oftentimes lead to postoperative dysphagia (21). Xie et al reported a complication rate of 10.7% in 2,233 of the cases after anterior cervical locking plate osteosynthesis, such as oblique plate implantations with partial nerve root irritation, soft tissue impairment and loosening or dislocation of screws and plates (8).…”

The Relationship Between Increased Intervertebral Disc Height (IDH) and Development of Postoperative Dysphagia After Single-level Anterior Cervical Discectomy and Fusion (ACDF) — A retrospective Study of 217 Cases

“…Currently, the sex-related difference in the incidence of postoperative dysphagia after ACDF also remains controversial. For example, Li et al 21 suggested that females were signi cantly more likely to have postoperative dysphagia than males. On the contrary, some studies showed there was no relationship between the gender and postoperative dysphagia [7][8][9]22 .…”