Risk factors for dysphagia after anterior cervical spine surgery

Abstract

Background:Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery.Methods:PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76–2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05–2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62–2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44–6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16–14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60–4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62–1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75–2.51, P = 0.30).Conclusion:Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required.

Exploratory meta-analysis on dose-related efficacy and complications of rhBMP-2 in anterior cervical discectomy and fusion: 1,539,021 cases from 2003 to 2017 studies

“…However, it was hard to meta-analyse dysphagia caused by low-dose rhBMP-2 through the above three studies because of lacking contemporary non-rhBMP-2 series. Additionally, dysphagia incidence could be influenced by female gender, multi-level surgery and surgical site at C3/4 [ 53 ]; the wound infections were only considered the wounds in the cervical spine site due to no bone graft collection site in the rhBMP-2 group. We expected that these confounding factors affecting the judges of rhBMP-2 could be eliminated in future well-designed blinded RCTs.…”

The Impact of Smoking on Radiological Outcomes in Patients After Total Arthroplasty of the Cervical Intervertebral Discs

“…Так, в метаанализе F.Y. Liu et al [20] наглядно продемонстрировано, что женский пол, проведение операции ТА на уровне межпозвонковых дисков C3-C4, а также выполнение протезирования двух и более дисков связано с развитием дисфагии в раннем послеоперационном периоде. В работе P.D.…”

Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up

“…[ 27 , 28 ] However, the complex anatomic structures around the upper cervical spine involving the C2 segment make it difficult to perform anterior surgery given the high complication rates, even for skilled surgeons. [ 29 ] According to the study of Liu et al, the surgery-related complication rate for multilevel cervical myelopathy was nearly 37.3% using the anterior approach. On the other hand, posterior surgical approach is safer and more effective regarding the development of surgery-related complications.…”