Risk factors for persistent dysphagia after anterior cervical spine surgery

Dysphagia is a relatively common complication of anterior cervical spine surgery. Smoking has not been definitively assessed as a risk factor for dysphagia. This study examined risk factors for dysphagia, including smoking and pain severity. The authors performed a cross-sectional cohort study of 100 patients who underwent anterior cervical diskectomy and fusion (ACDF). Dysphagia was assessed with the Yoo-Bazaz questionnaire. Clinical notes were reviewed for demographic information, diagnosis, preoperative pain severity, preoperative smoking status, and operative details. The dysphagia questionnaire was administered via telephone. The rate of dysphagia at an average of 2.75 years (33 months) was 26%. Rare and mild dysphagia were reported by 2% and 7% of patients, respectively. Moderate dysphagia was reported by 12% patients, and severe dysphagia was reported by 5% of patients. Smokers were more likely to report dysphagia symptoms, and their dysphagia scores were more severe than those in nonsmokers (1.17 vs 0.54; P=.02). Patients undergoing revision surgery (n=7) had dysphagia at a rate of 71% compared with 23% of patients undergoing primary surgery (P<.004). Age, sex, diagnosis, severity of preoperative pain, and number of levels treated did not reach statistical significance. The prevalence of persistent dysphagia at an average of 33 months after ACDF was 23% in primary cases. To the authors' knowledge, the severity of dysphagia in smokers has not been reported previously. These data confirm previous reports that dysphagia symptoms persist in a significant proportion of patients more than 1 year after anterior cervical spine surgery.