Postoperative Prevertebral Soft Tissue Swelling Does Not Affect the Development of Chronic Dysphagia Following Anterior Cervical Spine Surgery

Abstract

Prospective cohort study. To characterize the relation between postoperative soft tissue swelling and the development of chronic dysphagia after anterior cervical spine surgery. Chronic dysphagia was defined as dysphagia that persists more than 1 year. Dysphagia is commonly reported in the early postoperative period after anterior cervical spine surgery. Although prevertebral soft tissue swelling (STS) has been hypothesized as a potential risk factor for development of dysphagia, no studies have assessed STS' relation to dysphagia that persists more than 1 year. Sixty-seven patients who underwent elective anterior cervical spine surgery from 2008 to 2011 and completed a dysphagia questionnaire were included in the study. Prevertebral STS was measured at the caudal endplates of C2 and C6 on plain lateral cervical radiographs preoperatively, immediately after, and 6 and 12 weeks postoperatively. The presence and severity of chronic dysphagia was assessed using the Bazaz-Yoo Dysphagia Score. The prevalence of dysphagia in relation to STS was evaluated using the Wilcoxon rank-sum test. By 6 weeks after surgery, 89% of STS at C2 and 97% of STS at C6 had resolved, as compared with preoperative values. The overall dysphagia prevalence in our cohort was 73%, with 48% reporting no or mild symptoms. Moderate symptoms were present in 39% and severe symptoms were present in 13% of the patients. There was no relation between STS measured at all time points compared with the development of chronic dysphagia. Dysphagia did trend toward significance with higher cervical fusions (C4 and above) and as the number of levels fused increased, but STS did not seem to influence this. Postoperative STS is a self-limiting process. The magnitude of STS during the postoperative period does not seem to influence the development of chronic dysphagia.