Abstract
Objective: To identify the incidence, characteristics, treatment strategies, and outcomes for dysphagia after anterior cervical spinal surgery (ACSS). Design: Retrospective, case-controlled. Setting: 2 free-standing rehabilitation hospitals. Participants: All patients admitted to 2 rehabilitation hospitals over 3 years after ACSS. Interventions: Not applicable. Main Outcome Measures: American Speech-Language-Hearing Association National Outcome Measurement System (NOMS) Swallowing Scale, results of instrumental assessment for aspiration, laryngeal penetration, pharyngeal residue, and length of dysphagia treatment. Results: 46 patients were included in this study. Group 1 (n=31) included patients who presented with dysphagia after ACSS. Group 2 (n=15) included patients who presented with no dysphagia after ACSS. Mean age for group 1 was 56.35 years and group 2 was 52.40 years. The difference in age between the 2 groups was not statistically significant (F=.49, P=.487). Traumatic injuries versus nontraumatic injuries were equally represented in each group. In group 1, 32% presented with a concomitant brain injury and in group 2, 22%. A tracheotomy was present in 26% of group 1 subjects as compared with 13% in group 2 subjects. In group 1, 29% had either the SOMI or halo-brace as compared with 6.6% in group 2. In group 1, 61% had a cervical collar as compared with 93% in group 2. In group 1, mean NOMS swallowing level for admission was 2.806 and for discharge was 4.968. Gains made were considered statistically significant (F=17.12, P<.0001). 84% of group 1 underwent either a fluoroscopic or endoscopic swallow evaluation, with 50% presenting with aspiration, 62% with laryngeal penetration, and 81% with pharyngeal residue. Length of treatment ranged from 2 to 71 days (mean, 17.68d). Conclusion: Dysphagia after ACSS was present in 67.4% of the patients who were admitted to the rehabilitation hospitals. Aspiration, laryngeal penetration, and pharyngeal residue were common findings. These patients demonstrated significant progress with their dysphagia treatment during inpatient rehabilitation.
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