title: A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia.
abstract: To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery.
  
  
  
  A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia.
  
  
  
  The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554).
  
  
  
  Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.
authors.affiliation: Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA. kreinar1@hfhs.org.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Reinard
authors.affiliation: Division of Speech and Language Pathology, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Cook
authors.affiliation: Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Zakaria
authors.affiliation: Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Azam M
authors.initials: AM
authors.lastname: Basheer
authors.affiliation: Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Muwaffak M
authors.initials: MM
authors.lastname: Abdulhak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D055815:Young Adult
keywords: Anterior-posterior; Cervical spine; Dysphagia; Fusion; Risk factors