Perioperative Dysphagia Considerations for Patients With Severe Cervical Spondylotic Myelopathy

Study DesignCohort study with consecutive cases.ObjectivesDysphagia after anterior cervical spine surgery is a well-known complication. The aim of this study is to identify risk factors for dysphagia in patients with cervical myelopathy requiring surgery.MethodsWe conducted a prospective analysis of 92 consecutive patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical spine surgery. All patients underwent a pre- and postoperative swallowing evaluation using the Eating Assessment Tool (EAT-10) and the Hyodo-Komagane (H‒K) score, an endoscopic scoring method used by an examining otolaryngologist to assess dysphagia.ResultsNone of the patients had dysphagia when assessed using EAT-10; however, 15.2% of patients had H‒K scores indicative of dysphagia. Preoperative latent dysphagia was highly correlated with postoperative dysphagia (r = 0.51, P < 0.0001). No significant difference was found for the presence of dysphagia due to a history of smoking, dialysis, diabetes, asthma, and restrictive and/or obstructive ventilation disorder. The 10-s grip and release test (P < 0.0001) and the upper extremity function (P = 0.004) and bladder function (P = 0.0008) items from the Japanese Orthopaedic Association scores significantly correlated with H‒K scores.ConclusionThis study suggests that advanced age and severe preoperative upper limb and bladder dysfunction are risk factors for dysphagia in patients with cervical myelopathy requiring surgery.