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A Comparison of Patient-Centered Outcome Measures to Evaluate Dysphagia and Dysphonia After Anterior Cervical Discectomy and Fusion

Rosenthal, Brett D. MD; McCarthy, Michael H. MD, MPH; Bhatt, Surabhi BS; Savage, Jason W. MD; Singh, Kern MD; Hsu, Wellington K. MD; Patel, Alpesh A. MD, FACS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 15, 2019 - Volume 27 - Issue 22 - p 848-853
doi: 10.5435/JAAOS-D-17-00631
Research Article

Summary of Background Data: Dysphagia and dysphonia are the most common complications after anterior cervical diskectomy and fusion (ACDF). No consensus system exists currently in the spine literature for the classification of these conditions postoperatively.

Objective: The purpose of this analysis was to evaluate the validity and reliability of the Eating Assessment Tool (EAT-10) in the assessment of dysphagia when compared with the Bazaz score. A secondary goal was to assess the Voice Handicap Index (VHI-10) scores among patients following ACDF.

Methods: Patients treated with ACDF (one, two, or three level) for cervical radiculopathy and/or cervical myelopathy at two tertiary hospitals were administered patient-reported outcome metrics preoperatively as well as at multiple time points postoperatively. The metrics administered included the EAT-10, VHI-10, Bazaz, Neck Disbability Index, and EuroQol Five Dimensions questionnaire (EQ-5D)/visual analog scale.

Results: One hundred patients were included in this study. Eighty-nine percentage had a 1-year follow-up, and 100% had a 12-week follow-up. Mean Neck Disbability Index, EQ-5D, and EQ-visual analog scale scores all improved from baseline at both 6 months and 1 year postoperatively. Both the EAT-10 and VHI-10 demonstrated excellent internal reliability (α = 0.95 and α = 0.90, respectively). Analysis of variance of EAT-10 and VHI-10 scores by time point demonstrated a statistically significant relationship (P < 0.0001). The EAT-10 and VHI-10 scores were statistically greater on postoperative day 1 than at all other times (Tukey posthoc, P < 0.0001 and P < 0.004, respectively). Across all time points, 176 instances of clinically significant dysphagia (EAT-10 ≥ 3) were noted, 57 (32%) of which were classified as “None” on the Bazaz classification.

Conclusions: The EAT-10 score is an accurate measure for mild to severe dysphagia and better captured significant dysphagia that would have otherwise been missed when the Bazaz score is used. EAT-10 and VHI-10 are better measures of postoperative dysphagia and dysphonia than the current metrics used in spine surgery.

Study Design: This was a prospective cohort study of consecutive patients.

From the Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL (Dr. Rosenthal, Dr. McCarthy, Bhatt, Dr. Hsu, and Dr. Patel), the Cleveland Clinic, Center for Spine Health, Cleveland, OH (Dr. Savage), and the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Singh).

Correspondence to Dr. McCarthy:

None of the authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Funding provided by Northwestern University Department of Orthopaedic Surgery.

IRB approval was granted for this project via the Institutional Review Board Office Northwestern University.

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Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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