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Review
. 2024 Nov 20;16(11):e74127.
doi: 10.7759/cureus.74127. eCollection 2024 Nov.

Reducing Dysphagia Following Anterior Cervical Spine Surgery: Insights From a Meta-Analysis

Nissim Ohana  1 , Jonathan E J Koch  2 , David Schleifer  3 , Itzhak Engel  3 , Yuval Baruch  3 , Eyal Yaacobi  4
Affiliations
Review

Reducing Dysphagia Following Anterior Cervical Spine Surgery: Insights From a Meta-Analysis

Nissim Ohana et al. Cureus. .

Abstract

A systematic search was conducted across PubMed, Embase, and Cochrane Library databases to identify relevant studies. The analysis focused on the influence of surgical duration, the number of cervical levels treated, and implant types. A total of 21 studies were included, and heterogeneity among studies was evaluated using the I² statistic. The results indicated that longer surgeries, multi-level procedures, and certain implant designs were associated with an increased risk of dysphagia. In contrast, low-profile implants and stand-alone cage systems demonstrated a reduced risk compared to traditional plate-and-cage constructs. Anterior plates and specific cage designs were linked to higher dysphagia rates. The findings suggest that the risk of dysphagia after anterior cervical spine surgery (ACSS) is influenced by the length of surgery, the number of motion segments treated, and implant design. Optimizing these factors could help reduce postoperative complications and improve patient outcomes.

Keywords: anterior spine surgery; cervical disc disease; post operative dysphagia; spine surgery complications; systematic review and meta analysis.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart
PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ACSS - anterior cervical spine surgery
Figure 2
Figure 2. Risk of bias assessment for included studies
This figure illustrates the risk of bias assessment for the included studies, with part A summarizing the assessment for non-randomized studies and part B presenting the evaluation for the randomized controlled trial (RCT). Part A shows the evaluation of several domains of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool for non-randomized studies. The domains assessed include bias due to confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result. Each study is color-coded to indicate the level of bias: low - yellow, moderate - green, or high - red. The figure highlights areas where bias was low, such as participant selection, and areas with notable concerns, such as bias in the classification of interventions and the selection of reported results. Part B focuses on the RCT, assessed using the Cochrane Risk of Bias Tool. The table presents the evaluation of bias domains specific to RCTs, including selection bias, performance bias, detection bias, attrition bias, reporting bias, and other biases. Similar to Part A, the color coding indicates the degree of bias, with most concerns in the areas of performance and detection bias, while other areas, such as attrition and reporting bias, were rated as low.
Figure 3
Figure 3. Comparison of weighted risk ratios for dysphagia by implant type in cervical spine surgery
Figure 4
Figure 4. Comparison of pooled risk ratios for dysphagia by surgical and implant variables in cervical spine surgery
ACDF - anterior cervical discectomy and fusion
See this image and copyright information in PMC

References

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