Comparing Videofluoroscopic and Patient Reported Outcome Measures of Swallowing After ACDF Surgery

The purpose of this study is to compare findings from videofluoroscopic swallow studies (VFSS) with commonly used patient-reported outcome tools (PROs) after Anterior Cervical Discectomy and Fusion (ACDF). Our aims were to: (1) determine the impact of ACDF surgery on swallowing and dysphagia symptoms by comparing within-subject changes pre- to six weeks post- surgery; (2) compare prevalence, incidence, and rates of clinically meaningful change using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST^TM) and PRO scores; (3) explore how changes across individual PROs align with changes in DIGEST pre- to six weeks post- surgery.

This was a secondary analysis of data from 21 prospectively recruited participants undergoing primary ACDF. VFSS and PRO data was collected preoperatively and six weeks postoperatively. VFSS outcomes included the Modified Barium Swallowing Impairment Profile (MBSImP^TM©) pharyngeal total score and the DIGEST. PROs included the Bazaz Dysphagia Scale, the Eating Assessment Tool (EAT-10), the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the Hospital for Special Surgery Dysphagia Index (HSS-DDI).

Statistical models for all outcome measures revealed a significant effect of operative timepoint, indicating worse outcomes postoperatively. There were greater postoperative increases in point prevalence and incidence rates using PROs compared with DIGEST. Rates of clinically meaningful change were similar across PROs and DIGEST, but not consistently across the same individual cases.

This study highlights the difference between physical function and patient experience, suggesting the presence or absence of dysphagia symptoms may not correspond with observed physical impairments after ACDF.

Level III.