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Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion

Vaishnav, Avani S., MBBS; Saville, Philip, MD; McAnany, Steven, MD; Patel, Dil, BA; Haws, Brittany, MD; Khechen, Benjamin, BA; Singh, Kern, MD; Gang, Catherine Himo, MPH; Qureshi, Sheeraz A., MD, MBA∗,†

doi: 10.1097/BRS.0000000000002865
CERVICAL SPINE
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Study Design. Retrospective review of prospectively collected data.

Objective. To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF).

Summary of Background Data. Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy.

Methods. Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable.

Results. Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007).

Conclusion. Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.

Level of Evidence: 3

Operative time and preoperative swallowing quality of life scores are predictive of dysphagia in single level anterior cervical discectomy and fusion. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.

Hospital for Special Surgery, New York, New York

Weill Cornell Medical College, New York, New York

Midwest Orthopedics at Rush, Chicago, IL.

Address correspondence and reprint requests to Sheeraz A. Qureshi, MD, MBA, 535 E. 70th St., New York, NY 10017; E-mail: qureshis@HSS.EDU

Received 30 July, 2018

Accepted 14 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, royalties, stocks.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.