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Risk Factors associated with dysphagia for people with Cervical Spinal Cord Injury (cSCI): A Systematic review and
Sharon Leigh1,2, Chunhu Shi3,4, Ian Benson5
1School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK. Sharon.leigh@nhs.net.
Study Design:
Systematic Review.
Objectives:
This systematic review aimed to summarise evidence on the risk factors associated with dysphagia for people with Cervical Spinal Cord Injury (cSCI).
Setting:
Studies originate from multiple countries, no single study setting applies.
Methods:
We searched Medline and Embase (OVID), CENTRAL, CINAHL (EBSCOhost), Web of Science (Clarivate), ProQuest and Scopus on 16 January 2025 with an update on 27 July 2025 for prospective and retrospective cohort studies, cross-sectional and non-randomised observational longitudinal studies. These studies included patients aged ≥ 16 years with cSCI and no pre-existing oropharyngeal dysphagia or oesophageal dysphagia. Following standard Cochrane review methodology, two reviewers screened the search results and the full text papers of potentially relevant studies independently and then assessed methodological quality using Newcastle Ottawa Scale (NOS). The certainty of evidence was appraised using Grading of Recommendations, Assessments, Development and Evaluations (GRADE). Data were extracted using a piloted tool. Meta-analysis for each risk factor was conducted using RevMan, pooling Odds Ratios (ORs) from multivariate and univariate models.
Results:
Eighteen studies (2, 258 participants) were included. Our meta-analyses suggested that three risk factors had significant associations with dysphagia in cSCI: tracheostomy (OR = 4.91, 95% CI: 1.74 to 13.86, p = 0.003); being male (OR = 1.95, 95% CI:1.32 to 2.55, p = 0.0009) and combined anterior-posterior surgery (OR = 1.77, 95% CI: 1.17 to 2.70, p = 0.007). Other risk factors with promising but limited data included nasogastric tube presence.
Conclusions:
There is very low certainty evidence that the risk factor groups of tracheostomy, male gender and combined anterior-posterior neck surgery can predict dysphagia in cSCI. More robust and large-scale research with standardised outcome measures is required to explore the independent prognostic factors of dysphagia in cSCI.
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