Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate. The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: “dysphagia” and “anterior cervical discectomy and fusion” or “ACDF”. The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded. Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.

/pdf/dysphagia-as-a-postoperative-complication-of-anterior-3dvbqw6q.pdf

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

STUDY DESIGN
Prospective multi-center cohort study.


OBJECTIVE
To explore the association between operative level and postoperative dysphagia after anterior cervical discectomy and fusion (ACDF).


SUMMARY OF BACKGROUND DATA
Dysphagia is common following ACDF and has several risk factors including soft tissue edema. The degree of prevertebral soft tissue edema varies based upon the operative cervical level. However, the operative level has not been evaluated as a source of postoperative dysphagia.


METHODS
Adult patients undergoing elective ACDF were prospectively enrolled at three academic centers. Dysphagia was assessed using the Bazaz questionnaire, Dysphagia Short Questionnaire (DSQ), and Eating Assessment Tool-10 (EAT-10) preoperatively and at 2, 6, 12, and 24-weeks postoperatively. Patients were grouped based on inclusion of specific surgical levels in the fusion construct. Multivariable regression analyses were performed evaluating the independent effects of number of surgical levels and inclusion of each particular level on dysphagia symptoms.


RESULTS
A total of 130 patients were included. Overall, 24 (18.5%) patients had persistent postoperative dysphagia at 24 weeks and were older, female, and less likely to be drink alcohol. There was no difference in operative duration or dexamethasone administration. Patients with persistent dysphagia were significantly more likely to have C4-C5 included in the fusion construct (62.5% vs. 34.9%, P=0.024) but there were no differences based on inclusion of other levels. On multivariable regression, inclusion of C3-C4 or C6-C7 were associated with more severe EAT-10 (β:9.56, P=0.016 and β:8.15, P=0.040) and DSQ (β:4.44, P=0.023 and (β:4.27, P=0.030) at 6 weeks. At 12-weeks, C3-C4 fusion was also independently associated with more severe dysphagia (EAT-10 β:4.74, P=0.024).


CONCLUSION
The location of prevertebral soft tissue swelling may impact the duration and severity of patient-reported dysphagia outcomes at up to 24 weeks postoperatively. In particular, inclusion of C3-C4 and C4-C5 into the fusion may be associated with dysphagia severity.

Does operative level impact dysphagia severity following anterior cervical discectomy and fusion? a multicenter prospective analysis.

Prospective comparison of dysphagia following anterior cervical discectomy and fusion (ACDF) with and without rhBMP-2.

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Prospective comparison of dysphagia following anterior cervical discectomy and fusion (ACDF) with and without rhBMP-2.