A Hard Pill to Swallow: Dysphagia-Associated Factors Following Adult Cervical Deformity Surgery

Background: Dysphagia, a common and significant complication of cervical spine surgery, remains challenging to predict. This study aims to examine baseline patient characteristics and intraoperative risk factor influence on the incidence of dysphagia following adult cervical deformity (ACD) surgery. Methods: Retrospective Cohort Study of a Prospectively Enrolled Database. Patients with complete baseline (BL) and 2-year (2Y) follow-up data were analyzed. Dysphagia was defined by postoperative reports or SWAL-QOL scores < 25th percentile. Descriptive statistics, means comparison tests, cross-tabulations, and regression analyses were performed. Results: Of 265 patients included (mean age: 58.2 ± 11.4 years, BL BMI 28.5 ± 7.6 kg/m², CCI: 0.93 ± 1.3, BL frailty: 0.2 ± 0.1, operative time: 348 ± 194.9 min, and levels fused: 5.9 ± 3.6), 82 (30.9%) reported postoperative dysphagia. The dysphagia group demonstrated significantly greater BL frailty score (p < 0.001), BL C2-C7 (p = 0.002), and cSVA (p = 0.001). Longer operative time was associated with higher dysphagia risk (OR 1.004, p < 0.001). Anterior osteotomy at any level from C3-C7 demonstrated greater dysphagia rates (p < 0.02, all). Significant corrections of both C2-C7 and McGregor's Slope (MGS) predict dysphagia (OR 3.6, p < 0.001; OR 17.0, p = 0.009). Delayed extubation postoperatively significantly increased occurrence (80.0% vs. 20.0%, p = 0.015; OR 9.5, p = 0.047). Dysphagia appeared to be associated with early DJF (p = 0.034) and worse M3 NSR scores (p < 0.001). A multivariable logistic regression showed operative duration to be independently associated with postoperative dysphagia (OR 1.004 per minute, 95% CI 1.002-1.005, p < 0.001). The surgical approach was significant overall (Wald χ² = 6.44, df = 2, p = 0.040). However, compared with the anterior approach, neither the posterior nor the combined approach was found to be significantly associated with dysphagia (OR 0.95, 95% CI 0.40-2.28, p = 0.915; OR 2.11, 95% CI 0.81-5.48, p = 0.125). Conclusions: Dysphagia is associated with greater baseline frailty or deformity, undergoing mid-lower cervical osteotomies, significant correction, operative duration, or delayed extubation. Further investigation is warranted, given the small sample size of patients with delayed extubation. These findings underscore the importance of preoperative planning to mitigate dysphagia risk.