What Is the Incidence and Severity of Dysphagia After Anterior Cervical Surgery?

Rihn, Jeffrey A.; Kane, Justin M.; Albert, Todd J.; Vaccaro, Alexander R.; Hilibrand, Alan S.

doi:10.1007/s11999-010-1731-8

Cited by 177 publications

(167 citation statements)

References 29 publications

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“…In addition, postoperative hematoma and scar tissue formation should be ruled out, especially in cases of chronic dysphagia (76). However, the underlying pathophysiology of postoperative dysphagia remains poorly understood (77). With all the existing controversies, the low dysphagia incidence observed in our study may be related to the relative low rate of anterior cervical plate usage, the application of solely manual retraction with periodic pressure release, and the careful intraoperative soft-tissue handling.…”

Section: Dysphagiamentioning

confidence: 66%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

107

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Dysphagiamentioning

confidence: 66%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

107

113

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“…The severity and potential life-threatening nature of these complications from anterior cervical spinal surgery have prompted more thorough evaluations of their incidence and associated risk factors. 3,6,9,11,13,19,24,[27][28][29]33 The reported rates of dysphagia after anterior cervical surgery have varied widely, from 1% to 79%. 9 In a prospective study, Lee et al 19 found the prevalence of postoperative dysphagia at 1, 2, 6, 12, and 24 months to be 54%, 34%, 19%, 15%, and 14%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Jeyamohan¹,

Kenning²,

Petronis³

et al. 2015

SPI

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OBJECT Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema. METHODS A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment. RESULTS Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively). CONCLUSIONS Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected. Clinical trial registration no.: NCT01065961 (clinicaltrials.gov)

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“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

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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What Is the Incidence and Severity of Dysphagia After Anterior Cervical Surgery?

Abstract: Level II, prospective, comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 177 publications

References 29 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial

Dysphagia following combined anterior-posterior cervical spine surgeries

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