Subjective and Functional Dysphagia After Anterior Cervical Spine Surgery: A Prospective Controlled Study

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Otolaryngology

Background:

• Dysphagia is a frequent postoperative complaint after anterior cervical discectomy and fusion (ACDF), with reported incidence rates varying widely.
• The significant variability in reported dysphagia rates necessitates a clearer understanding of its clinical significance and natural history.
• This study aimed to characterize the temporal progression and impact of dysphagia following anterior cervical surgery using both subjective and objective assessments.

Purpose of the Study:

• To evaluate the incidence and time course of dysphagia after anterior cervical surgery.
• To assess the impact of dysphagia on patients using validated subjective and objective measures.
• To differentiate between transient dysphagia and a true postoperative complication.

Main Methods:

• Prospective enrollment of patients undergoing cervical or lumbar spine surgery.
• Assessment of dysphagia using the Eating Assessment Tool (EAT-10) and Yale Swallow Protocol at multiple postoperative time points (PODs 0, 3, 7, 30).
• Objective measurement of retropharyngeal space dimensions via radiography at various time points.

Main Results:

• Dysphagia was significantly more prevalent in the cervical ACDF group compared to the lumbar decompression group across all assessed postoperative time points.
• EAT-10 scores demonstrated a strong correlation across postoperative time points and a modest correlation with operative duration.
• Radiographic measurements showed increased retropharyngeal swelling immediately postoperatively, which largely resolved by follow-up, except at C3 and C4.

Conclusions:

• Dysphagia is a frequent and expected symptom following anterior cervical surgery, typically peaking in the early postoperative period.
• The observed pattern of partial resolution by one month supports classifying dysphagia as a common, self-limited postoperative symptom rather than a complication in most instances.
• Subjective (EAT-10) and objective (radiographic) measures provide valuable insights into the management and understanding of postoperative dysphagia.