What is the incidence and severity of dysphagia after anterior cervical surgery?

Abstract

Background: Existing studies suggest a relatively high incidence of dysphagia after anterior cervical decompression and fusion (ACDF). The majority of these studies, however, are retrospective in nature and lack a control group.

Questions/purposes: We therefore (1) prospectively determined the incidence and severity of dysphagia after ACDF using lumbar decompression patients as a control group; and (2) determined which factors, if any, are associated with increased postoperative dysphagia.

Methods: Patients undergoing either one- or two-level ACDF (n=38) or posterior lumbar decompression (n=56) were prospectively followed. Baseline patient characteristics were recorded. A dysphagia questionnaire was administered preoperatively and during the 2-week, 6-week, and 12-week postoperative visits. We found no differences in patient age, body mass index, or the preoperative incidence and severity of dysphagia between the cervical and lumbar groups. We compared the incidence and severity of dysphagia between the patients who had cervical and lumbar surgery.

Results: Postoperatively, 71% of patients having cervical spine surgery reported dysphagia at 2 weeks followup. This incidence decreased to 8% at 12 weeks followup. The incidence and severity of dysphagia were greater in the cervical group at 2 and 6 weeks followup with a trend toward greater dysphagia at 12 weeks followup. Body mass index, gender, location of surgery, and the number of surgical levels were not related to the risk of developing dysphagia. We observed a correlation between operative time and the severity of postoperative dysphagia.

Conclusions: Dysphagia is common after ACDF. The incidence and severity of postoperative dysphagia decreases over time, although symptoms may persist at least 12 weeks after surgery.

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

Fig. 1

Comparison of the overall incidence of dysphagia between the cervical and lumbar groups preoperatively and at each of the follow-up time periods (ie, 2 weeks, 6 weeks, 12 weeks).