Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study.
METHODS
Retrospective analysis of the incidence and prevalence of dysphagia after anterior cervical decompression and fusion (ACDF).


OBJECTIVE
To examine the incidence and prevalence of dysphagia after ACDF, determine possible associated patient and procedural characteristics, and examine dysphagia's impact on long-term health status and function.


BACKGROUND
Dysphagia is a common early complaint after ACDF, but the risk factors associated with its development are not understood.


METHODS
Telephone surveys (Cervical Spine Outcomes Questionnaire) and clinical assessments (Oswestry Neck Disability Scale and SF-36) were used to evaluate 454 patients who had undergone ACDF at one of 23 nationwide sites for individual and procedure characteristics that might contribute to dysphagia.


RESULTS
Of the 454 patients, 30% reported dysphagia at the 3-month assessment (incident cases). The incidence of new complaints of dysphagia at each follow-up point was 29.8%, 6.9%, and 6.6% at 3, 6, and 24 months, respectively. Dysphagia persisted at 6 and 24 months in 21.5% and 21.3% of patients, respectively. The risk of dysphagia increased with number of surgical vertebral levels at 3 months: 1 level, 42 of 212 (19.8%); 2 levels, 50 of 150 (33.3%); 3+ levels, 36 of 92 (39.1%). Patients reporting dysphagia at 3 months had a significantly higher self-reported disability and lower physical health status at subsequent assessments.


CONCLUSIONS
Duration of preexisting pain and the number of vertebral levels involved in the surgical procedure appear to influence the likelihood of dysphagia after ACDF.
Riley
Lee H
LH
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ehenze1@jhmi.edu
Skolasky
Richard L
RL
Albert
Todd J
TJ
Vaccaro
Alexander R
AR
Heller
John G
JG
D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000706:statistics & numerical data; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data