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Lower Incidence of Dysphagia With Cervical Arthroplasty Compared With ACDF in a Prospective Randomized Clinical Trial

McAfee, Paul C. MD*; Cappuccino, Andrew MD; Cunningham, Bryan W. MSc*; Devine, John G. MD; Phillips, Frank M. MD§; Regan, John J. MD; Albert, Todd J. MD; Ahrens, Jeanette E. PhD

doi: 10.1097/BSD.0b013e31819e2ab8
Original Articles

Study Design The current study of 251 consecutive 1-level anterior cervical reconstructions was undertaken to compare the incidence of dysphagia between cervical disk replacement and conventional anterior cervical fusion and instrumentation.

Objectives This is a report of 251 patients from 5 investigational centers in the Food and drug Administration's prospective, randomized porous-coated motion (PCM) trial using a validated dysphagia outcomes instrument. The dysphagia data for both PCM and anterior cervical diskectomy and fusion (ACDF) patients were reviewed from 5 centers to (1) compare the severity of dysphagia, (2) compare the postoperative incidence of dysphagia, and (3) to compare the resolution of perioperative dysphagia.

Summary of Background Data Dysphagia and dysphonia after anterior surgical approaches to the cervical spine have been previously reported. The current prospective, randomized investigation quantifies clinical dysphagia based on 3 criteria-severity, incidence, and resolution—in a time-course evaluation.

Methods Patients between 18 and 65 years with 1-level symptomatic cervical radiculopathy and/or myelopathy for progressive neurologic symptoms, were randomized to undergo anterior decompression and PCM arthroplasty (N=151) or ACDF (control) (N=100). Patients self-reported dysphagia severity using the Bazaz scale preoperatively and at follow-up. The Bazaz scale has 4 classes of severity based upon the problems with swallowing that the patient has with both liquids and solids.

Results The Bazaz results demonstrate that although both the PCM and ACDF groups exhibited an initial postoperative problem with swallowing, the PCM group continued to improve with increasing time after implantation, whereas the ACDF only improved minimally. The PCM treatments indicated significantly lower incidence of dysphagia at 3 and 12 months postoperatively compared with ACDF controls (P<0.05). An increase in dysphagia severity at either the 6-week or 3-month follow-up visit was reported in 35 (42%) PCM and 29 (64%) ACDF subjects. Long-term resolution of these symptoms was noted in 74% (26/35) of the PCM subjects as compared with 41.4% (12/29) of the ACDF subjects (P=0.015).

Conclusions In a prospective randomized clinical study the incidence of postoperative dysphagia and the long-term resolution of the dysphagia was greatly improved in the PCM group compared with the instrumented ACDF control group.

*St. Joseph Medical Center, Scoliosis and Spine Center, Baltimore, MD

Lockport Hospital, Buffalo, NY

Madigan Army Base, Seattle, WA

§Rush Presbyterian Hospital, Chicago, IL

Cedars Sinai Hospital, Los Angeles, CA

Rothman Institute, Chestnut Street, Philadelphia, PA

Pivotal Research Solutions, South Greenville Avenue, Allen, TX

Reprints: Paul C. McAfee, MD, St. Joseph Medical Center, Scoliosis and Spine Center, O'Dea Medical Building ♯104, 7505 Osler Drive, Towson, MD 21204 (e-mail:

Received for publication June 28, 2008; accepted December 29, 2008

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.