title: Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy.
abstract: BACKGROUND
  Anterior cervical discectomy (ACD) is widely used for symptomatic cervical spine pathologies. The most common complications associated with this type of surgery are dysphagia and dysphonia; however, the risk factors associated with them have not been adequately elucidated. The purpose of this study is to assess the incidence of self-reported dysphagia and dysphonia and the associated risk factors after ACD.
  
  
  METHODS
  This study used a retrospective chart review of 149 patients who underwent ACD at a tertiary care facility operating in the New York metropolitan area over a period of 2½ years. Charts for ACD patients were reviewed by 6 trained researchers. Incidence rates for self-reported dysphagia and dysphonia were calculated using 95% exact confidence intervals (CI). Risk factors such as age, sex, surgical hours, number of disc levels, airway class, American Society of Anesthesiologists class, fiberoptic intubation, and intubation difficulty were assessed using logistic regression.
  
  
  RESULTS
  The incidence of self-reported dysphagia was 12.1% (95% exact CI, 7.3%-18.4%); for dysphonia the self-reported incidence was 5.4% (95% exact CI, 2.3%-10.3%). Patients who underwent surgery at ≥4 cervical levels had a significant 4-fold increased risk (odds ratio=4; 95% CI, 1.1-13.8) of developing dysphonia and/or dysphagia compared with patients who underwent surgery at a single surgical level.
  
  
  CONCLUSIONS
  This study confirms previous findings that the risk of developing dysphagia and/or dysphonia increases with the number of surgical levels, with multiple cervical levels representing a significantly higher postoperative risk, as compared with surgery at 1 level.
authors: Physiologic Assessment Services, Teaneck, NJ, USA.
authors: Joseph
authors: J
authors: Danto
authors: John
authors: J
authors: DiCapua
authors: Dominic
authors: D
authors: Nardi
authors: Renee
authors: R
authors: Pekmezaris
authors: Gregory
authors: G
authors: Moise
authors: Martin
authors: M
authors: Lesser
authors: Paola
authors: P
authors: Dimarzio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D017586:Diskectomy / Q000009:adverse effects*; D055154:Dysphonia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors