title: Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis.
abstract: BACKGROUND
  Dysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia.
  
  
  OBJECTIVE
  To determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Forty-three patients.
  
  
  METHODS
  Validated dysphagia questionnaire, lateral cervical spine radiographs.
  
  
  METHODS
  Patients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling.
  
  
  RESULTS
  Forty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point.
  
  
  CONCLUSIONS
  There is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rihn
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Bennett
authors.forename: David G
authors.initials: DG
authors.lastname: Anderson
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003680:Deglutition Disorders / Q000209:etiology*; D017586:Diskectomy / Q000009:adverse effects*; D004487:Edema / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*