The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: A prospective study

Abstract

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). The incidences of dysphagia were variable and controversial. The purpose of this study was to determine the incidence of early dysphagia after ACSS with a new scoring system, and to identify the risk factors of it. A prospective study was carried out and patients who underwent ACSS from March 2014 to August 2014 in our hospital were included in this study. A self-designed dysphagia questionnaire was delivered to all of the patients from the first day to the fifth day after ACSS. Perioperative characteristics of patients were recorded, and incidences and risk factors of dysphagia were analyzed. A total of 104 patients who underwent ACSS were included and incidences of dysphagia from the first to the fifth day after ACSS was 87.5%, 79.81%, 62.14%, 50% and 44.23%, respectively. There was a good correlation between the new dysphagia scoring system and Bazaz scoring system (P < 0.001). Operative time and body mass index (BMI) were the risk factors for dysphagia during the first to the second day postoperatively. However, the dC2-C7angle was the main risk factor for dysphagia from the third to the fifth day after surgery. There were comparatively high incidences of early dysphagia after ACSS, which may be ascribed to operative time, BMI and the dC2-C7 angle.

Effects of Body Mass Index on Perioperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery

“…In a retrospective multicenter study of 2,827 ACDFs, Wang et al [ 30 ] also found that patients who developed immediate postoperative dysphagia had a higher BMI than those who did not (27.3 vs. 24.6 kg/m 2 , p ≤ 0.001). Liu et al [ 27 ] reported a similar result during the first to second postoperative days. Our results agree with these studies, that obesity is associated with early postoperative dysphagia.…”

“…Incidence rates of dysphagia after ACDF vary in the literature from 1 to 79% [29][30][31] . A large database study with 2,723 patients conducted by Chung et al reported an incidence of 2.3%, with patients over 70 years old having higher risk 32 .…”

“…A c c e p t e d A r t i c l eincreased thickness of the pre-vertebral tissue in obese patients, which leads to excessive esophageal retraction 30. Soft tissue edema, direct laceration of the esophagus, local ischemia due to increased intraesophageal pressure, pharyngeal plexus denervation by retractors, superior laryngeal nerve injury, or recurrent laryngeal nerve stretch injury during the lateralization of the larynx are possible etiologies for the development of dysphagia.29 In contrast, Rihn et a.l31 and …”

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

“…The authors have suggested the association between obesity and early-dysphagia may be linked to the increased thickness of the prevertebral tissue in obese patients, leading to difficulty in manipulation and excessive esophageal retraction. 26,30,31 Finally, while no past study has elucidated the implication of frailty in the development of dysphagia, the present publication demonstrated a significant association. Frailty which is defined as hypoalbuminemia, muscle weakness or fatigue may make patients especially susceptible to more intraoperative tissue manipulation and thus at increased risk of postoperative dysphagia.…”

“…In contrast to some studies regarding obesity [ 6 , 27 , 29 ], our results showed that body mass index was significantly associated with dysphagia. Similarly, Wang et al [ 26 ] and Liu et al [ 30 ] found increased rates in the immediate postoperative period only. The authors have suggested the association between obesity and early-dysphagia may be linked to the increased thickness of the prevertebral tissue in obese patients, leading to difficulty in manipulation and excessive esophageal retraction [ 26 , 30 , 31 ].…”