Realistic long-term dysphagia rates after anterior cervical discectomy with fusion: is there a correlation with postoperative sagittal alignment and lordosis at a minimum 2-year follow-up?

Rong XieDepartment of Neurological Surgery, University of California, San Francisco, California;
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; and

Search for other papers by Rong Xie in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Jinping LiuDepartment of Neurological Surgery, University of California, San Francisco, California;
Department of Neurosurgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China

Search for other papers by Jinping Liu in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Minghao WangDepartment of Neurological Surgery, University of California, San Francisco, California;

Search for other papers by Minghao Wang in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Yinhui DongDepartment of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; and

Search for other papers by Yinhui Dong in
jns
Google Scholar
PubMed
Close
 MD
,
Praveen V. MummaneniDepartment of Neurological Surgery, University of California, San Francisco, California;

Search for other papers by Praveen V. Mummaneni in
jns
Google Scholar
PubMed
Close
 MD, MBA
, and
Dean ChouDepartment of Neurological Surgery, University of California, San Francisco, California;

Search for other papers by Dean Chou in
jns
Google Scholar
PubMed
Close
 MD
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

OBJECTIVE

Postoperative dysphagia after anterior cervical discectomy and fusion (ACDF) has many contributing factors, and long-term data are sparse. The authors evaluated dysphagia after ACDF based on levels fused and cervical sagittal parameters.

METHODS

Patients who underwent ACDF between 2009 and 2018 at the University of California, San Francisco (UCSF), were retrospectively studied. Dysphagia was evaluated preoperatively, immediately postoperatively, and at last follow-up using the UCSF dysphagia score. Dysphagia was categorized as normal (level 7), mild (levels 5 and 6), moderate (levels 3 and 4), and severe (levels 1 and 2). The UCSF mild dysphagia score was further classified as "minimal dysphagia," while moderate and severe dysphagia were classified as "significant dysphagia." "Any dysphagia" included any dysphagia, regardless of grade. Cervical sagittal parameters were measured preoperatively, immediately postoperatively, and at last follow-up.

RESULTS

A total of 131 patients met inclusion criteria. The mean follow-up was 43.89 (24–142) months. Seventy-eight patients (59.5%) reported dysphagia immediately postoperatively, and 44 patients (33.6%) reported some dysphagia at last follow-up (p < 0.001). The rates of moderate dysphagia were 13.0% immediately postoperatively and 1.5% at the last follow-up (p < 0.001). Twenty-two patients (16.8%) had significant dysphagia immediately postoperatively, and 2 patients (1.5%) had significant dysphagia at last follow-up (p < 0.001). Patients with immediate postoperative dysphagia had less C2–7 preoperative lordosis (−9.35°) compared with patients without (−14.15°, p = 0.029), but there was no association between C2–7 lordosis and dysphagia at last follow-up (p = 0.232). The prevalence rates of immediate postoperative dysphagia and long-term dysphagia were 87.5% and 58.3% in ≥ 3-level ACDF; 64.0% and 40.0% in 2-level ACDF; and 43.9% and 17.5% in 1-level ACDF, respectively (p < 0.001).

CONCLUSIONS

The realistic incidence of any dysphagia after ACDF was 59.5% immediately postoperatively and 33.6% at the minimum 2-year follow-up, higher than previously published rates. However, most dysphagia was not severe. The number of fused levels was the most important risk factor for long-term dysphagia, but not for immediate postoperative dysphagia. Loss of preoperative C2–7 lordosis was associated with immediate postoperative dysphagia, but not long-term dysphagia. ACDF segmental lordosis and cervical sagittal vertical axis were not associated with long-term dysphagia in ACDF.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; cSVA = cervical sagittal vertical axis; UCSF = University of California, San Francisco; VFSS = video-fluoroscopic swallowing study.

Supplementary Materials

    • Tables S1 and S2 (PDF 466 KB)
  • Collapse
  • Expand

Images from Gami et al. (pp 713–721).

  • 1

    Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607624.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602617.

  • 3

    Cheung KM, Mak KC, Luk KD. Anterior approach to cervical spine. Spine (Phila Pa 1976). 2012;37(5):E297E302.

  • 4

    Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech. 2005;18(5):406409.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Min Y, Kim WS, Kang SS, Choi JM, Yeom JS, Paik NJ. Incidence of dysphagia and serial videofluoroscopic swallow study findings after anterior cervical discectomy and fusion: a prospective study. Clin Spine Surg. 2016;29(4):E177E181.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Tian W, Yu J. The role of C2-C7 angle in the development of dysphagia after anterior and posterior cervical spine surgery. Clin Spine Surg. 2017;30(9):E1306E1314.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):24532458.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Edwards CC II, Karpitskaya Y, Cha C, et al. Accurate identification of adverse outcomes after cervical spine surgery. J Bone Joint Surg Am. 2004;86(2):251256.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Wei T, Zhao L. Applications of bone drilling techniques in spinal surgery. Article in Chinese. Zhonghua Yi Xue Za Zhi. 2015;95(13):961964.

  • 10

    Cloward RB. New method of diagnosis and treatment of cervical disc disease. Clin Neurosurg. 1962;8:93132.

  • 11

    Frempong-Boadu A, Houten JK, Osborn B, et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech. 2002;15(5):362368.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Pedram M, Castagnera L, Carat X, Macouillard G, Vital JM. Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone. Eur Spine J. 2003;12(1):8490.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919924.

  • 14

    Cheney DM, Siddiqui MT, Litts JK, Kuhn MA, Belafsky PC. The ability of the 10-Item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol. 2015;124(5):351354.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Skeppholm M, Ingebro C, Engström T, Olerud C. The Dysphagia Short Questionnaire: an instrument for evaluation of dysphagia: a validation study with 12 months’ follow-up after anterior cervical spine surgery. Spine (Phila Pa 1976). 2012;37(11):9961002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Kepler CK, Rihn JA, Bennett JD, et al. Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis. Spine J. 2012;12(8):639644.

  • 17

    Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery?. Clin Orthop Relat Res. 2011;469(3):658665.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Yew AY, Nguyen MT, Hsu WK, Patel AA. Quantitative risk factor analysis of postoperative dysphagia after anterior cervical discectomy and fusion (ACDF) using the Eating Assessment Tool-10 (EAT-10). Spine (Phila Pa 1976). 2019;44(2):E82E88.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):4959.

  • 20

    Rofes L, Arreola V, Mukherjee R, Clavé P. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):12561265.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Radcliff KE, Bennett J, Stewart RJ, et al. Change in angular alignment is associated with early dysphagia after anterior cervical discectomy and fusion. Clin Spine Surg. 2016;29(6):248254.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Tian W, Yu J. The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery. Dysphagia. 2013;28(2):131138.

  • 23

    Andrew SA, Sidhu KS. Airway changes after anterior cervical discectomy and fusion. J Spinal Disord Tech. 2007;20(8):577581.

  • 24

    Danto J, DiCapua J, Nardi D, et al. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol. 2012;24(4):350355.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Lovasik BP, Holland CM, Howard BM, Baum GR, Rodts GE, Refai D. Anterior cervical discectomy and fusion: comparison of fusion, dysphagia, and complication rates between recombinant human bone morphogenetic protein-2 and beta-tricalcium phosphate. World Neurosurg. 2017;97:674683.e1.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Smith-Hammond CA, New KC, Pietrobon R, Curtis DJ, Scharver CH, Turner DA. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29(13):14411446.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Siska PA, Ponnappan RK, Hohl JB, Lee JY, Kang JD, Donaldson WF III. Dysphagia after anterior cervical spine surgery: a prospective study using the swallowing-quality of life questionnaire and analysis of patient comorbidities. Spine (Phila Pa 1976). 2011;36(17):13871391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Chin KR, Eiszner JR, Adams SB Jr. Role of plate thickness as a cause of dysphagia after anterior cervical fusion. Spine (Phila Pa 1976). 2007;32(23):25852590.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Lee MJ, Bazaz R, Furey CG, Yoo J. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J. 2007;7(2):141147.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Alves LM, Cassiani RDA, Santos CM, Dantas RO. Gender effect on the clinical measurement of swallowing. Arq Gastroenterol. 2007;44(3):227229.

  • 31

    Hughes TA, Wiles CM. Clinical measurement of swallowing in health and in neurogenic dysphagia. QJM. 1996;89(2):109116.

Metrics

All Time Past Year Past 30 Days
Abstract Views 766 766 79
Full Text Views 194 194 82
PDF Downloads 177 177 62
EPUB Downloads 0 0 0