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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Dysphagia 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Five 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>A 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.</jats:p></jats:sec>

Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery

“…The safety and effectiveness of a 2-team approach to revision anterior cervical spine surgery has been described previously in the literature. 3,10,17 As the number of ACDFs performed annually is projected to increase in the future as the population ages, an otolaryngologist practicing in an acute hospital setting is likely to encounter these postoperative patients. Therefore, understanding which patients are at risk preoperatively and how to counsel them postoperatively is imperative.…”

“…19 In a 2016 meta-analysis of 238 patients, Erwood et al 16 estimated the rate of recurrent laryngeal injury after revision ACDF to be 14.1% using dysphagia as a proxy for recurrent laryngeal injury. The most similar comparison study is the 2018 prospective study by Erwood et al 17 of dysphagia and vocal cord palsy among patients undergoing 2-team reoperative ACDF. In this series of 67 patients, patients underwent indirect laryngoscopy pre- and postoperatively.…”

Assessment of Acoustic Voice Parameters After Anterior Cervical Discectomy and Fusion

“…Despite otolaryngologists who may have never performed ACDF, training in neck dissection, laryngectomy, and thyroid surgeries prepare surgeons for challenging dissections, including revisions, patients with neck ankylosis, and post-radiation. This may explain why the multidisciplinary approach in ACDF reduces the incidence of RLN palsy [ 13 ].…”

Epidemiology of Swallowing Disorders in Rheumatoid Arthritis: Prevalence, Risk Factors, and Quality of Life Burden

“…34 Although originally validated on head and neck cancer patients, the MDADI's use as a quality-of-life measure has been extended to other populations and diseases, including autoimmune conditions. [35][36][37][38][39] Along with these items were 2 scale measures intended to explore the relation between the severity of RA and the frequency of swallowing symptoms and disorders. The Rheumatoid Arthritis Pain Scale (RAPS), 40 a psychometrically validated instrument, was included to measure pain, a major complaint in individuals with RA and often the major limiting factor related to function and mobility.…”