title: Comparison of Long-term Differences in Dysphagia: Cervical Arthroplasty and Anterior Cervical Fusion.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  This study investigates the incidence of long-term dysphagia in cervical disc arthroplasty, and anterior cervical discectomy and fusion (ACDF) patients.
  
  
  BACKGROUND
  No long-term comparison of dysphagia between cervical arthroplasty and fusion patients has been published. Widely variable short-term postsurgical dysphagia rates have been reported.
  
  
  METHODS
  Cohorts for this study are patients with single-level cervical degenerative disc disease previously enrolled in a randomized clinical trial comparing cervical arthroplasty and ACDF. Subjective modified Bazaz Dysphagia Severity questionnaires were distributed to each patient at a minimum of 5 years postoperative for the long-term assessment. Dysphagia severity data were pooled to compare the rate of patients with dysphagia (grade>1) to asymptomatic (grade=1).
  
  
  RESULTS
  In the arthroplasty cohort, 15 of 22 (68%) patients completed long-term swallowing questionnaires with no reports of dysphagia. Eighteen of 25 (72%) ACDF patients completed questionnaires, with 5 of 18 (28%) reporting dysphagia. This is a statistically significant difference (P=0.042) favoring lower rates of long-term dysphagia after cervical arthroplasty at an average interval of 7 years postoperative (range, 5.5-8.5 y). No significant difference between rates of self-reported short-term dysphagia was noted with 12% (3/25) and 9% (2/22) in the ACDF and arthroplasty groups, respectively (P=0.56). All short-term dysphagia cases in the arthroplasty cohort reported complete resolution of symptoms within 12 months postoperative. In the ACDF cohort, persistent symptoms at 7 years were noted in all responding patients. Three ACDF patients reported new late-onset, which was not noted in the arthroplasty cohort.
  
  
  CONCLUSIONS
  To date, these findings represent the longest reported follow-up interval comparing rates of dysphagia between randomized cohorts of cervical arthroplasty and fusion patients. Our study suggests that cervical arthroplasty is less likely than ACDF to cause sustained long-term or late-presenting dysphagia.
authors.affiliation: *Indiana Spine Group, Carmel, IN †Gundersen Health System, La Crosse ‡Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Smucker
authors.forename: Scott R
authors.initials: SR
authors.lastname: Bassuener
authors.forename: Rick C
authors.initials: RC
authors.lastname: Sasso
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome