P27. Incidence of dysphonia vs dysphagia/odynophagia following zero profile ACDF

Abstract

<h3>BACKGROUND CONTEXT</h3> Stand-alone or zero-profile devices for anterior cervical discectomy and fusion (zero-profile ACDF) have become popular in the management of degenerative cervical spine disease in order to mitigate some of the complications associated with anterior cervical plating. Studies regarding the incidence of postoperative complications after zero-profile ACDF are limited, particularly with regard to postoperative dysphonia. <h3>PURPOSE</h3> The aim of this study is to determine the incidence and overlap of voice and swallowing symptoms in patients undergoing zero-profile ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who had undergone zero-profile ACDF between 2017-2020. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - Patient reported responses on the Dysphagia, Odynophagia and Voice (DOV) Questionnaire. <h3>METHODS</h3> Patients completed the DOV Questionnaire preoperatively and at each postoperative timepoint (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year and 2 years) as standard of care. The DOV Questionnaire requires patients to select one of five scaled answer choices (0-4) for dysphagia, and one of four scaled answer choices (0-3) for voice (ie, dysphonia) and odynophagia, with zero indicating no symptoms and higher point values indicating worse symptomatology. For this study, scores of 1, 2, 3, and 4 were graded as mild, moderate, severe, and very severe, respectively. The incidence of dysphonia, dysphagia and odynophagia were assessed. <h3>RESULTS</h3> Forty-eight patients, with a mean age of 58.46 ± 9.74 years, mean BMI of 27.38 ± 4.76 kg/m^2 and comprised of 31 males (64.6%) and 17 females (35.4%) were included. There were 17 single-level (35.4%), 24 two-level (50.0%) and 7 three-level (14.6%) surgeries. Twenty-four (50.0%) patients reported either new-onset dysphonia, dysphagia or odynophagia at their 2 or 6 week postoperative visit following zero-profile ACDF. Of these, 3 patients (6.25%) reported only dysphonia, 11 patients (22.9%) reported only dysphagia/odynophagia, and 10 patients (20.8%) reported both dysphonia and dysphagia/odynophagia. All cases of dysphagia and odynophagia were mild and a majority resolved within 12 weeks. Similarly, a majority (69%) of cases of dysphonia were mild and also resolved by 12 weeks. <h3>CONCLUSIONS</h3> Half of the patients in this cohort reported either dysphonia, dysphagia or odynophagia within 6 weeks of ACDF with the use of a zero-profile implant, most of which were mild and transient, resolving by 12 weeks. About half of all patients with swallowing symptoms reported concurrent voice symptoms, whereas the other half reported dysphagia/odynophagia alone. In contrast, approximately a quarter of all patients reported dysphonia within 6 weeks of zero-profile ACDF, most of whom also reported concurrent swallowing issues. However, 6.25% of patients reported dysphonia alone, which may not be detected using outcome measures that assess dysphagia only. Future research should evaluate these findings in a larger patient cohort and identify ways to reduce these complications. <h3>FDA DEVICE/DRUG STATUS</h3> Stand-alone ACDF cage (Approved for this indication).