Incidence and severity of postoperative dysphagia after short-segment anterior cervical fusion, corpectomy, or arthroplasty.

Abstract

Postoperative dysphagia occurs frequently after anterior cervical surgery. In this study, dysphagia incidence and duration were assessed in a multicenter cohort of patients who had undergone short-segment anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or cervical disc arthroplasty (CDA). The authors hypothesized that CDA would demonstrate the lowest dysphagia burden; ACCF, the highest; and ACDF, an intermediate burden. Authors retrospectively analyzed consecutive adult patients who underwent short-segment anterior cervical surgery, including CDA, ACDF, and ACCF, from 2010 to 2020 at three institutions. The 10-item Eating Assessment Tool (EAT-10) was used to assess for the occurrence of dysphagia and its persistence, the primary outcomes. An EAT-10 score ≥ 3 was defined as the threshold for dysphagia. Assessment for predictors of postoperative dysphagia was the secondary outcome. Univariate and regression analyses were performed. Authors identified 1466 patients who had been treated with 1- or 2-level ACDF (n = 1296), 1-level ACCF (n = 50), or 1- or 2-level CDA (n = 120). Significant differences in age, BMI, race, comorbidities, education level, and surgical characteristics were observed between and among surgical techniques. Preoperatively, the mean EAT-10 score was 1.6 for the whole cohort, increasing to 6.0 at 1 month after surgery and then decreasing to 2.5 and 2.4 at 3 and 12 months, respectively. At 1 month, dysphagia was present in 57% of patients after ACDF, 61% after ACCF, and 42% after CDA; at 12 months, dysphagia rates were 24%, 37%, and 17%, respectively. In patients without preexisting dysphagia (n = 1261), mean EAT-10 scores were 0.1 at baseline, increasing to 5.1 at 1 month and decreasing to 2.0 and 1.8 at 3 and 12 months, respectively. Within this patient subset at 1 month, dysphagia was present in 52% after ACDF, 60% after ACCF, and 39% after CDA; at 12 months, rates were 18%, 36%, and 12%, respectively. Compared to patients without preexisting dysphagia, those with baseline dysphagia had increased risks for postoperative dysphagia at the 1-month (OR 4.53, 95% CI 2.66-7.72), 3-month (OR 4.81, 95% CI 3.31-6.99), and 12-month (OR 6.69, 95% CI 4.40-10.2) follow-ups. At 3 months after surgery, other predictors of dysphagia were ACCF (OR 2.31, 95% CI 1.10-4.85) and diabetes (OR 1.71, 95% CI 1.22-2.41), whereas antithrombotic use indicated lower odds of dysphagia (OR 0.66, 95% CI 0.46-0.93). At the 12-month follow-up, female sex (OR 1.73, 95% CI 1.24-2.43), coronary artery disease (OR 2.25, 95% CI 1.29-3.93), and chronic pulmonary disease (OR 1.83, 95% CI 1.11-3.00) indicated greater odds of dysphagia. Although dysphagia resolved in the great majority of patients, a not insignificant portion had residual symptoms at the 12-month follow-up. Various risk factors for dysphagia, including greater age, female sex, ACCF, and comorbidities such as diabetes, cardiac disease, and pulmonary disease, were observed. CDA compared to ACDF was not found to reduce the risk of dysphagia. These findings can help inform shared decision-making and postoperative counseling.