What is the incidence of dysphagia after posterior cervical surgery?
METHODS
Prospective comparative study.


OBJECTIVE
To determine whether dysphagia is a unique complication of anterior neck dissection or whether it occurs after any cervical surgery.


BACKGROUND
Dysphagia is a common complication after anterior cervical discectomy and fusion. However, current literature is scarce whether dysphagia occurs as a direct result of the anterior approach (dissection or instrumentation) or because of cervical spine surgery itself.


METHODS
Patients undergoing posterior cervical surgery were prospectively evaluated for dysphagia up to 6 months after surgery. Patients were evaluated for dysphagia preoperatively, at 2 weeks and 6 weeks postoperatively using the dysphagia numeric rating scale. The data was compared with a previously published cohort of anterior cervical and lumbar surgical procedures from the same institution. Statistical significance was evaluated using the Fisher exact test.


RESULTS
Eighty-five patients were included who underwent posterior cervical surgery. Baseline dysphagia was present in 11% (10/85) of patients. The incidence of new dysphagia was 10 of 85 (11%) at 2 weeks, 8 of 85 (8%) at 6 weeks, 13 of 85 (13%) at 12 weeks, and 5 of 85 (6%) at 24 weeks. The incidence of new dysphagia was significantly less than that of anterior cervical surgery at 2 weeks (posterior [P] 11% vs. anterior [A] 61.5%, P = 0.0001), 6 weeks (P 8% vs. A 44%, P = 0.0001), but not 12 weeks (P 13% vs. A 11%, P = 1). The incidence of dysphagia after posterior cervical surgery was significantly increased compared with that of lumbar surgery at 2 weeks (P 11% vs. lumbar surgery [L] 9%, P = 0.78), 6 weeks (P 8% vs. L 0%, P = 0.02), and 12 weeks (P 13% vs. L 0%, P = 0.007). At 12 weeks postoperatively, there was a statistically significant increase in postoperative neck pain (P = 0.008), tightness (P = 0.032), and peripheral pain/numbness (P = 0.032) in patients with dysphagia.


CONCLUSIONS
Both anterior and posterior cervical surgery may result in long-term dysphagia in a small number of patients, perhaps due to loss of motion or postoperative pain. Surgeons should counsel their patients about possibility for dysphagia prior to all cervical spine surgery.
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. kris.radcliff@rothmaninstitute.com
Kristen E
KE
Radcliff
Loukas
L
Koyonos
Corey
C
Clyde
Gursukhman S
GS
Sidhu
Michael
M
Fickes
Alan S
AS
Hilibrand
Todd J
TJ
Albert
Alexander R
AR
Vaccaro
Jeffrey A
JA
Rihn
D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D013997:Time Factors