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Functional Assessment of Dysphagia and Dysphonia Following C3-C4 Anterior Spine Surgery: A Prospective Comparison
Pasquale De Bonis1,2, Sharon Giannini1, Roberta Alexandra Moldovan3
1Department of Neurosurgery, Sant'Anna University Hospital, Ferrara (FE), Italy.
Study Design:
Single-center prospective cohort study.
Objective:
To prospectively evaluate postoperative dysphagia and dysphonia in patients undergoing C3-C4 anterior cervical discectomy and fusion (ACDF) with the Simplified Retropharyngeal (SR) approach and the standard anterolateral (AL) approach.
Summary Of Background Data:
The C3-C4 level lies adjacent to the pharyngolaryngeal complex and represents a transition zone between the SR and AL approaches. In this region, modest retraction can translate into clinically relevant dysphagia and dysphonia. Currently, no prospective study has directly evaluated and compared functional swallowing and voice outcomes between these two techniques.
Methods:
Consecutive adult patients undergoing primary C3-C4 ACDF were prospectively enrolled. Patients were matched 1:2 (SR:AL) based on sex, age, and BMI, resulting in 75 total patients (25 SR, 50 AL). Patient-reported outcome measures (DHI, VHI) and clinician-rated outcomes (DOSS, GRBAS Grade) were collected preoperatively and at multiple postoperative timepoints up to 180 days. Outcomes were analyzed using mixed-effects models.
Results:
Baseline characteristics and operative times were comparable between groups, with no adverse events recorded. Early postoperative patient-reported symptoms were common (mean DHI 9.1 vs 8.9 for SR vs AL at ≤24 hours) but improved to near-zero by 90 days and resolved by 180 days. Adjusted models revealed no significant differences in DHI or VHI between approaches at any visit. Clinician-rated impairment was uncommon, improved rapidly, and showed no significant between-approach differences.
Conclusion:
This study found that early postoperative patient-reported swallowing and voice symptoms were common but improved rapidly, completely resolving by the last follow-up. Clinician-rated dysphagia and dysphonia were infrequent and returned to normal by 30 days with both approaches, with no statistically significant differences.
Level Of Evidence:
III.
