Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures.

Abstract

A 3-year prospective, cohort study. To compare the incidence and risk factors of dysphagia after anterior cervical (AC), posterior cervical (PC), and posterior lumbar (PL) spine procedures. Dysphagia is a known risk of AC surgery; however, comprehensive postoperative swallow evaluations have not been performed for a comparative cohort of AC, PC, and PL surgery patients. Eighty-three patients were enrolled in the study, including 38 undergoing AC, 19 PC, and 26 PL procedures. Preoperative and postoperative swallowing evaluations were performed by questioning for subjective swallowing complaints and performing objective radiographic examination. Patients with severe dysphagia leading to an increased risk of aspiration were identified and treated until recovery or for 3 to 9 months. Comparison of preoperative and postoperative swallowing complaints revealed a significant increase for AC patients (P < 0.01) and a trend for PC (P = 0.06) and PL (P = 0.09) patients. Eighteen (47%) AC, 4 (21%) PC, but no PL patients demonstrated dysphagia on postoperative videofluoroscopic swallow evaluation. Age (>60 years, P < 0.01) was associated with increased risk of radiologic evidence of dysphagia. Surgical level, instrumentation, operative time, and presence of myelopathy or other comorbidities were not. Over 70% (12 of 17) of AC patients with dysphagia followed recovered within 2 months, while 23% (4 of 17) required some level of compensatory swallowing behavior up to 10 months following surgery. Dysphagia is a common occurrence after AC procedures but was also found after PC procedures. Intubation alone was not a risk factor for postoperative dysphagia in this cohort.