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Dysphagia Risk After Single vs Multi-level Anterior Cervical Discectomy and Fusion in Octogenarians: A Propensity
Christopher D Hamad1, Joshua Wiener1,2,3, Tim Gutierrez4
1Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA.
Spine
|August 4, 2026
Summary
Multi-level anterior cervical discectomy and fusion (ACDF) increases acute dysphagia risk in octogenarians. Advanced age also elevates early dysphagia risk following ACDF, necessitating targeted counseling and management strategies.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Otolaryngology
Background:
- Dysphagia is a common complication following anterior cervical discectomy and fusion (ACDF).
- The impact of surgical extent and advanced age on dysphagia risk after ACDF requires further clarification.
- Octogenarians may experience more severe consequences from postoperative dysphagia.
Purpose of the Study:
- To assess the independent associations between the extent of surgery (single-level vs. multi-level ACDF) and advanced age with the risk of postoperative dysphagia.
- To compare dysphagia rates in octogenarians undergoing ACDF versus younger patients.
- To identify risk factors for dysphagia after ACDF in elderly patients.
Main Methods:
- Retrospective cohort study utilizing the TriNetX Research Network (2015-2023).
- Propensity score matching (1:1) was employed to balance demographics and comorbidities between cohorts.
- Primary outcome: new-onset dysphagia at 0-2 weeks, 6-24 weeks, and 1-2 years post-ACDF.
Main Results:
- Multi-level ACDF was associated with a higher risk of dysphagia at 0-2 weeks compared to single-level ACDF in octogenarians (11.5% vs. 8.0%).
- Octogenarians exhibited increased early dysphagia rates (0-2 weeks) after both single-level (7.7% vs. 4.5%) and multi-level ACDF (11.6% vs. 8.0%) compared to younger patients.
- These age-related differences in dysphagia risk resolved by 6-24 weeks post-surgery.
Conclusions:
- Multi-level ACDF in octogenarians is linked to a greater risk of acute dysphagia.
- Advanced age is a significant factor contributing to increased early dysphagia following ACDF.
- Findings support the need for focused patient counseling and proactive dysphagia management strategies in elderly ACDF patients.