Dysphagia rates between long-segment anterior versus posterior cervical fusion

Dysphagia is a common postoperative adverse outcome of cervical spinal fusion surgery and frequently associated with anterior surgical approaches and multilevel fusions. However, postoperative dysphagia has also been observed following posterior approaches, despite the absence of esophageal manipulation with this technique, thereby leaving the underlying mechanism unclear. This study aimed to investigate the impact of surgical approach on the incidence of new-onset postoperative dysphagia following long-segment (≥ 3 levels) anterior cervical fusion (ACF) and posterior cervical fusion (PCF) surgical procedures at 1, 3, and 12 months postoperatively. Patient-reported outcomes (PROs) were also compared between surgical approaches.

A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients who underwent long-segment cervical surgery were categorized on the basis of anterior or posterior approach received, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores and PROs were examined. Mixed-effects logistic regressions were performed to examine the impact of surgical approach on new-onset postoperative dysphagia.

Of the 328 patients who met the inclusion criteria, there were 208 ACF patients and 120 PCF patients. ACF patients experienced significantly greater improvement in Neck Disability Index score from baseline to 12 months postoperatively (-10.8 ± 9.4 vs -7.5 ± 8.6, p = 0.010) with no significant difference in baseline scores (19.0 ± 9.9 for ACF patients vs 17.6 ± 9.8 for PCF patients, p = 0.20). ACF patients also reported greater baseline visual analog scale-arm pain scores (5.7 ± 3.1 vs. 4.3 ± 3.4, p < 0.001) and experienced significantly greater improvement at 12 months postoperatively (-3.8 ± 3.5 vs. -2.2 ± 3.6, p = 0.001). A similar degree of improvement from baseline to 12 months was observed in other PROs regardless of surgical approach. Multivariable regressions indicated that the anterior surgical approach for long-segment cervical surgery was associated with significantly higher odds of experiencing new-onset postoperative dysphagia at 1 month (OR 15.0, 95% CI 1.89-120, p = 0.010) and 3 months (OR 3.25, 95% CI 1.20-8.74, p = 0.020) after cervical spine surgery but not at 12 months (OR 0.75, 95% CI 0.23-2.46, p = 0.6).

Patients who underwent anterior cervical surgery were significantly more likely to develop new-onset dysphagia as long as 3 months after surgery. However, long-term dysphagia rates were similar between cohorts. While initial dysphagia may be related to surgical approach, similar long-term rates suggest that persistent dysphagia may be related to the intraoperative and postoperative factors shared between surgical approaches.