Local Retropharyngeal Space Anesthetic for Dysphagia Reduction after Anterior Cervical Discectomy and Fusion Surgery: A Single-Center, Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Symptoms and coping of patients with dysphagia after anterior cervical spine surgery: a qualitative study

AIM

To explore the subjective symptoms, psychological characteristics and coping strategies of patients with dysphagia after anterior cervical spine surgery, so as to provide the basis for formulating strategies to help patients with dysphagia solve clinical practice problems and to improve their quality of life after surgery.

METHODS

Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 22 participants with dysphagia at 3-time points after anterior cervical spine surgery (7 days, 6 weeks, and 6 months).

RESULTS

A total of 22 (10 females and 12 males) patients, with years old ranging between 33 and 78 years were interviewed. When analysing the data, the following 3 categories were extracted from the participant interviews: "Subjective symptoms, Coping style and impact on social life". The 3 categories consist of 10 sub-categories.

CONCLUSIONS

The results showed that swallowing-related symptoms may occur after anterior cervical spine surgery. Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms, but lacked professional guidance from health care professionals. Moreover, dysphagia after neck surgery has its unique characteristics, involving the interaction of physical, emotional and social factors, which requires early screening.Healthcare professionals should provide better psychological support in the early or late postoperative period to ensure the improvement of health outcomes and patients' quality of life.

Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury

INTRODUCTION

Early detection and management of dysphagia are essential for preventing aspiration pneumonia and reducing mortality in patients with cervical spinal cord injury (C-SCI). In this study, we identified risk factors for dysphagia in patients with C-SCI by analyzing the correlation between the clinical factors and the severity of dysphagia, not the presence or absence of dysphagia. Combined with the analysis results of previous studies, we thought that this additional analysis method could more accurately reveal the risk factors for dysphagia in patients with C-SCI.

METHODS

The presence and severity of dysphagia in patients with C-SCI was evaluated using a modified videofluoroscopic dysphagia scale (mVDS) and penetration-aspiration scale (PAS). All included patients with C-SCI performed a video fluoroscopic swallowing study (VFSS). Clinical factors such as age, sex, the presence of tracheostomy, spinal cord independence measure (SCIM), pulmonary function test (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), American Spinal Cord Injury Association (ASIA) score, Berg Balance Scale (BBS), and operation method were investigated.

RESULTS

In the multivariate regression analysis, the anterior surgical approach was the only clinical factor that had a significant correlation in both mVDS and PAS, which represents the severity of dysphagia in C-SCI patients (p < 0.05).

CONCLUSION

The anterior surgical approach was correlated with the severity of dysphagia in patients with C-SCI. Considering this, as one of the risk factors affecting dysphagia in patients with C-SCI, surgical method may also need to be considered. Additionally, we recommend that clinicians should pay particular attention to the potential for development of dysphagia in patients who received anterior cervical surgery. However, further prospective studies with larger sample sizes are needed for more accurate generalization.

Dysphagia after cervical spine surgery: a review of risk factors and preventative measures

Dysphagia is a regular occurrence after cervical spine surgery, and the development of dysphagia postoperatively is associated with worsened quality of life for patients. Despite the frequency and negative implications of this adverse outcome, there is no clear consensus for defining dysphagia within the spinal literature. Numerous patient-reported outcomes questionnaires are currently used to elucidate the presence and severity of postoperative dysphagia, several of which are not validated instruments. This variability in reporting creates difficulty when trying to determine the prevalence of dysphagia and any potential mitigating factors. In the current review, the authors discuss the causes of postoperative dysphagia after cervical spine surgery, metrics for evaluating postoperative dysphagia, risk factors for the development of this adverse outcome, and strategies for preventing its development. Readers will be able to use this information to improve patient outcomes after cervical spine surgery.

Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis

STUDY DESIGN

A systematic review and meta-analysis.

OBJECTIVE

To evaluate the safety and efficacy of local steroid application (LSA) on dysphagia after anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA

Dysphagia is one of the most common adverse events in the early postoperative period of ACDF. LSA is reported as an effective method to reduce the swelling of soft tissues, thereby decreasing the incidence of dysphagia. However, the safety and efficacy of LSA on dysphagia after ACDF need to be systematically reviewed and analyzed.

METHODS

A comprehensive literature search was carried out in the database PubMed, Web of Science, EMBASE, Clinical key, Cochrane library, and Wiley Online Library to screen papers that report LSA in ACDF surgery. The Cochrane Collaboration tool and a methodological index for nonrandomized studies were used for the assessment of study quality. Data were analyzed with the Review Manager 5.3 software.

RESULTS

A total of 10 studies were included. The results revealed no significant differences between the steroid group and the control group in ACDF regarding postoperative drainage, estimated blood loss, and neck disability index score (P > 0.05). LSA significantly alleviates visual analog scale score for neck pain (or odynophagia) (P < 0.05), reduces the length of hospital stay (weighted mean difference, -1.00 (-1.05 to -0.95); P < 0.001), and mitigates dysphagia rate and prevertebral soft-tissue swelling in the early postoperative period (P < 0.05). There seemed to be no significant increase in the complication rate and steroid-related adverse events in the steroid group compared with the control group (P < 0.05).

CONCLUSIONS

LSA shows advantages in reducing the length of hospital stay, decreasing dysphagia rate, and mitigating prevertebral soft-tissue swelling in the early postoperative period of ACDF. Further large-scale studies are urgently required for the development of a standard protocol for LSA and further analysis of potential delay complications.

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate.

The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: “dysphagia” and “anterior cervical discectomy and fusion” or “ACDF”. The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded.

Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.