4:54 Risk factors for the development of dysphagia after anterior cervical spine surgery

Abstract

Purpose of study: Dysphagia is a recognized complication of the anterior approach to the cervical spine. The incidence and natural history of postoperative dysphagia is not well understood. Furthermore, the factsors that may increase the risk of postoperative dysphagia have not been defined.Methods used: A total of 231 consecutive patients underwent anterior cervical spine surgery; 200 patients were available for follow-up. There were 103 males and 97 females. The average age of the patients was 52.7±10.0 years. Patients were contacted at 1, 2, 6 and 12 months postoperatively. Symptoms were graded as mild, moderate or severe. The relationship between dysphagia and such factors as age, gender, surgical procedure (discectemy vs. corpectemy) and number of surgical levels were assessed.of findings: At 1 month after the procedure, 50.4% of patients were experiencing dysphagia. The incidence decreased to 31.1%, 16.2% and 14.3% at 2, 6 and 12 months, respectively (Fig. 1) . The average age of patients with dysphagia was 50.1±7.7 years, compared with 54.8±13.3 for the asymptomatic group. Male patients had a 9.7% incidence of postoperative swallowing difficulty compared with 23.8% incidence in female patients (p<.02). The incidence was 16.4 in primary surgical cases and 15.6% in revision anterior cervical cases. Patients who underwent discectemy had an 18.2% incidence. The dysphagia rate was 14.1% after corpectemy. The rate of swallowing difficultly was 13.0% in the absence of anterior hardware. This rate increased to 19.2% when an anterior plate was applied. When the surgical procedure involved on disc level, the incidence of dysphagia was 11.9%. The rate increased to 16.6% when two surgical levels were addressed. Intervention at three or more disc levels resulted in a 20.0% incidence of postoperative dysphagia.Relationship between findings and existing knowledge: Dysphagia after anterior cervical spine surgery is common initially (50.4% at 1 month). The rate decreases with time after the procedure (16.2% at 6 months). The incidence does not decrease after 6 months (14.3 at 12 months). By 6 months after the procedure, the majority of symptomatic patients experience only mild dysphagia (six patients with moderate or severe dysphagia at 6 months). Age, revision status and the type of procedure did not affect the incidence of postoperative dysphagia. Women had a significantly higher rate of post operative dysphagia. We do not have an explanation for this observation. Patients who underwent multilevel surgery or anterior hardware placement tended to have a higher incidence of dysphagia. As we expand our study, we expect that use of hardware and higher number of operative levels will prove to be statistically significant risk factors.Overall significance of findings: Overall, the incidence of significant dysphagia after 6 months is low. However, many patients do experience significant dysphagia early postoperatively. Most of the patients who experience dysphagia at 6 months have very mild symptoms. This demonstrates that an anterior approach to cervical spine is safe and well tolerated.Disclosures: No disclosures.Conflict of interest: No conflicts.