Clinical StudyRisk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study
Introduction
Severe and disabling dysphagia is a relatively uncommon complication of anterior cervical spine surgery. However, the prevalence of dysphagia ranges widely (2% to 60%) [1], [2], [3], [4], [5] and most studies are retrospective. The identification of adverse reactions after surgery in a retrospective fashion may not be entirely accurate [6]. Furthermore, risk factors that contribute to the development of dysphagia have not been well identified. This study is a prospective cohort study designed to evaluate the prevalence of dysphagia at 1, 2, 6, 12, and 24 months. Also, factors such as age, gender, type of surgery (eg, discectomy vs. corpectomy, primary vs. revision), use of instrumentation, and number and location of surgical levels are analyzed for the development of dysphagia.
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Materials and methods
Between 1999 and 2002, 348 cervical spine surgeries were performed using the anterior Smith Robinson approach. The study was approved by the Institutional Review Board of University Hospitals of Cleveland. All patients with preoperative dysphagia were excluded from the study. Three fellowship trained orthopedic spine surgeons, and one senior spine surgeon at a single institution performed all the procedures. Anesthetic care included the use of an inflated endotracheal cuff and an esophageal
Incidence of risk factors
Female gender and surgeries involving at least three levels were previously found to be significant risk factors for the development of dysphagia [5]. The incidences of these risk factors were separately evaluated within each subgroup. There were no significant differences in the gender makeup of each subgroup. However, the corpectomy group had significantly higher number of surgeries involving at least three levels than the discectomy group (p<.01), and the noninstrumented group had
Discussion
The development of dysphagia after anterior cervical spine surgery is being recognized as common. The purpose of this study was to identify risk factors for developing dysphagia after anterior cervical spine procedures. In addition, another goal was to determine the prevalence and severity of dysphagia.
Widely ranging prevalences of dysphagia after anterior spine surgery have been reported. However, most of these studies are retrospective. There are few prospective studies examining dysphagia
Conclusion
The etiology of dysphagia in the postoperative period is likely multifactorial. Other possible factors not examined in this study include: duration of operation, manual versus self-retaining retraction, prolonged intubation, and amount of intravenous fluids during the operation. Postsurgical edema is probably the strongest contributor to dysphagia in the early postoperative period (1 and 2 months). However, in the later recovery period (1 and 2 years), the amount of scar tissue likely plays a
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