title: The impact of esophagus retraction on early dysphagia after anterior cervical surgery: does a correlation exist?
abstract: METHODS
  Prospective study of 92 patients who underwent anterior cervical surgery. Intraoperative esophagus retraction and postoperative dysphagia were recorded and evaluated.
  
  
  OBJECTIVE
  Early dysphagia after anterior cervical discectomy and fusion is an underestimated side effect. The aim of this study was to investigate whether postoperative swallowing disturbances correlate with the amount of intraoperative retraction of the pharynx/esophagus wall measured during the procedure.
  
  
  BACKGROUND
  The anterior approach to the cervical spine is a routinely used and, in general, safe procedure. A recent prospective study focused on the underreported side effect of postoperative dysphagia, with an incidence of up to 50% at 1 month and 12.5% at 12 months. The etiology of postoperative dysphagia is not known in detail.
  
  
  METHODS
  An online pressure transducer between the retractor and pharynx/esophagus recorded the epi-esophageal pressure in 92 patients. In 31 patients, a transducer was additionally inserted into the pharynx/esophagus in order to measure the endo-esophageal pressure. The patients rated swallowing difficulty during the first postoperative 5 days using a 10-point score. A control group of 32 lumbar surgery patients was also evaluated for swallowing disturbances.
  
  
  RESULTS
  Mean epi-esophageal pressure after retractor opening was 76.3 mm Hg, and mean endo-esophageal pressure was 16.3 mm Hg. An adjustment to 75% and 76%, respectively, of the initial value occurred within the first hour. Of patients, 49.3% complained of swallowing disturbances. There was a significant prevalence of the female gender. No correlation between the amount of retraction and postoperative dysphagia was observed.
  
  
  CONCLUSIONS
  A correlation between intraoperative pharynx/esophagus retraction and postoperative swallowing disturbances could not be confirmed. The cause of the prevalence of the female gender is unknown. However, the absence of impaired deglutition in the control group suggests that a local phenomenon must be causative of swallowing disturbances following anterior cervical discectomy and fusion.
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Luca
authors.initials: L
authors.lastname: Papavero
authors.forename: Oliver
authors.initials: O
authors.lastname: Heese
authors.forename: Volker
authors.initials: V
authors.lastname: Klotz-Regener
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Buchalla
authors.forename: Frank
authors.initials: F
authors.lastname: Schröder
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology*; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011312:Pressure; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013525:Surgical Instruments; D014159:Transducers