The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery.
OBJECTIVE
Little data are available regarding the influence of psychiatric factors on chronic dysphagia after anterior cervical spine surgery. The purpose of this study was to identify associations between psychiatric factors and the development of chronic dysphagia in patients after anterior cervical spine surgery.


METHODS
The authors prospectively examined 72 patients with degenerative disc disease of the cervical spine who were treated by single-level anterior cervical discectomy and fusion. Demographic data including age, gender, body mass index, and smoking status were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Neck Disability Indices (NDI), and the Neck Pain and Disability Scale (NPDS) were assessed before surgery and at final follow-up. Psychiatric conditions were evaluated using the Zung depression scale and the Zung anxiety scale. At 1 year postoperatively, patients were contacted by telephone to determine the presence and severity of dysphagia. For statistical analyses, patients were divided into two groups: group I, those with No or Mild dysphagia; and group II, those with Moderate or Severe dysphagia at 1 year after surgery. Potential risk factors of chronic dysphagia were evaluated by multivariate logistic regression analysis.


RESULTS
The patients included 22 women and 50 men of overall average age 47.1 ± 7.8 years. The prevalences of No/Mild (group I) and Moderate/Severe (group II) dysphagia were 69.4% (50 patients) and 30.6% (22 patients), respectively. Mean preoperative NDI, NPDS, PCS, and MCS scores of 34.2, 44.8, 33.7, and 46.2 in the 72 study subject improved to 9.9, 16.1, 55.1, and 56.2, respectively, at 1 year after surgery. The mean preoperative ZDS and ZAS scores were 35.2 and 34.2, respectively. The two study groups were significantly different in terms of the presence of a psychiatric problem, preoperative NDIs, and MCS scores. However, multivariate logistic regression showed that the presence of a psychiatric problem prior to surgery (P = 0.005) was the only significant predictor of chronic dysphagia.


CONCLUSIONS
The presence of a psychiatric problem seems to be an important risk factor of chronic dysphagia in patients with cervical disc herniation. The study shows that psychiatric factors should be evaluated prior to surgery to determine the risk of chronic dysphagia.
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Sung Shik
SS
Kang
Jung Sub
JS
Lee
Jong Ki
JK
Shin
Jae Myung
JM
Lee
Bu Hyun
BH
Youn
D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects; D016896:Treatment Outcome