The Impact of Esophagus Retraction on Early Dysphagia After Anterior Cervical Surgery

Papavero, Luca; Heese, Oliver; Klotz-Regener, Volker; Buchalla, Rüdiger; Schröder, F; Westphal, Manfred

doi:10.1097/01.brs.0000261627.04944.cf

Cited by 70 publications

(63 citation statements)

References 27 publications

(21 reference statements)

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“…2,4,7,[12][13][14]18,19,23,24,29,35,[41][42][43][44]46,47 Prospective analyses featuring questionnaires report a higher rate of dysphagia, ranging from 20% to 71%. 5,15,[25][26][27][28][30][31][32]34,35,37,38,48,49 These prospective studies are comparable to the present study. Using a questionnaire, Lee et al 27 reported the incidence of subjective dysphagia at multiple time points during the 2 years after surgery.…”

Section: Discussionsupporting

confidence: 80%

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEDysphagia and vocal cord palsy (VCP) are common complications after anterior cervical discectomy and fusion (ACDF). The reported incidence rates for dysphagia and VCP are variable. When videolaryngostroboscopy (VLS) is performed to assess vocal cord function after ACDF procedures, the incidence of VCP is reported to be as high as 22%. The incidence of dysphagia ranges widely, with estimates up to 71%. However, to the authors’ knowledge, there are no prospective studies that demonstrate the rates of VCP and dysphagia for reoperative ACDF. This study aimed to investigate the incidence of voice and swallowing disturbances before and after reoperative ACDF using a 2-team operative approach with comprehensive pre- and postoperative assessment of swallowing, direct vocal cord visualization, and clinical neurosurgical outcomes.METHODSA convenience sample of sequential patients who were identified as requiring reoperative ACDF by the senior spinal neurosurgeon at the University of Alabama at Birmingham were enrolled in a prospective, nonrandomized study during the period from May 2010 until July 2014. Sixty-seven patients undergoing revision ACDF were enrolled using a 2-team approach with neurosurgery and otolaryngology. Dysphagia was assessed both preoperatively and postoperatively using the MD Anderson Dysphagia Inventory (MDADI) and fiberoptic endoscopic evaluation of swallowing (FEES), whereas VCP was assessed using direct visualization with VLS.RESULTSFive patients (7.5%) developed a new postoperative temporary VCP after reoperative ACDF. All of these cases resolved by 2 months postoperatively. There were no new instances of permanent VCP. Twenty-five patients had a new swallowing disturbance detected on FEES compared with their baseline assessment, with most being mild and requiring no intervention. Nearly 60% of patients showed a decrease in their postoperative MDADI scores, particularly within the physical subset.CONCLUSIONSA 2-team approach to reoperative ACDF was safe and effective, with no new cases of VCP on postoperative VLS. Dysphagia rates as assessed through the MDADI scale and FEES were consistent with other published reports.

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Section: Discussionsupporting

confidence: 80%

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Erwood¹,

Walters²,

Connolly

et al. 2018

Journal of Neurosurgery: Spine

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“…2,5,6,9,10,12,16,18,21,22,[27][28][29]31,32 However, the associations are not consistent among studies.…”

mentioning

confidence: 79%

“…5,6,9,23 However, there are a number of studies that have reported significantly higher incidences of dysphagia in women. 2,13,21 The potential relationship between patient sex and postsurgical dysphagia remains to be clarified. Also consistent with previous reports, 2,6,13,21,23 no significant association between age and dysphagia was found in our study.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia following combined anterior-posterior cervical spine surgeries

Chen

Saulle

et al. 2013

SPI

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C ompliCations related to cervical spine surgery are well documented in the literature, including dysphagia, dysphonia, wound infection, neurological deficit, delayed C-5 palsy, adjacent-level disease, instrumentation failure, and pseudarthrosis. 4,7 Among these, dysphagia has been a consistently recognized early complication following anterior cervical spine surgery, and its reported incidence is highly variable, ranging from 1% to as high as 79%. 2,3,5,6,10,14,22,24,28,33 This variation is in part attributed to how dysphagia is defined by investigators and the threshold of severity at which it is considered to be a complication. Fortunately, most studies show dysphagia to be typically a transient phenomenon following anterior cervical surgery. 2,22,31 The pathophysiology of dysphagia following cervical spine surgery remains poorly understood. Several factors have been suggested to be related to the development of postsurgical dysphagia, including patient age, female sex, obesity, length of surgery, specific spinal level(s) of surgery, multilevel surgery, use of instrumen- Object. This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries.Methods. The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and/or fiberoptic endoscopic evaluation of swallowing/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed.Results. In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2-7 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput-C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No ...

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“…Contributing factors include prevertebral soft tissue swelling, vocal cord paresis, 4,6,7 scar tissue formation, hardware complication and cervical graft material. 1,4,8 Risk factors that have been identified include multilevel fusion and female gender, 3,4,9,10 revision surgery, 5 and plate prominence. 2,11 Given that dysphagia is a common complication of anterior cervical spine surgery, numerous techniques have been investigated to decrease its incidence, decreased plate prominence and cuff pressure are just a few.…”

Section: Introduction Rationalementioning

confidence: 99%

Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: A systematic review

et al. 2017

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The Impact of Esophagus Retraction on Early Dysphagia After Anterior Cervical Surgery

Cited by 70 publications

References 27 publications

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach

Dysphagia following combined anterior-posterior cervical spine surgeries

Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: A systematic review

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