1
|
Paziuk T, Mazmudar AS, Issa TZ, Henry TW, Patel AA, Hilibrand AS, Schroeder GD, Kepler CK, Vaccaro AR, Rihn JA, Brodke DS, Bisson EF, Karamian BA. Does Operative Level Impact Dysphagia Severity After Anterior Cervical Discectomy and Fusion?: A Multicenter Prospective Analysis. Spine (Phila Pa 1976) 2024; 49:909-915. [PMID: 38369769 DOI: 10.1097/brs.0000000000004965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
STUDY DESIGN Prospective multicenter cohort study. OBJECTIVE To explore the association between operative level and postoperative dysphagia after anterior cervical discectomy and fusion (ACDF). BACKGROUND Dysphagia is common after ACDF and has several risk factors, including soft tissue edema. The degree of prevertebral soft tissue edema varies based on the operative cervical level. However, the operative level has not been evaluated as a source of postoperative dysphagia. PATIENTS AND METHODS Adult patients undergoing elective ACDF were prospectively enrolled at 3 academic centers. Dysphagia was assessed using the Bazaz Questionnaire, Dysphagia Short Questionnaire, and Eating Assessment Tool-10 (EAT-10) preoperatively and at 2, 6, 12, and 24 weeks postoperatively. Patients were grouped based on the inclusion of specific surgical levels in the fusion construct. Multivariable regression analyses were performed to evaluate the independent effects of the number of surgical levels and the inclusion of each particular level on dysphagia symptoms. RESULTS A total of 130 patients were included. Overall, 24 (18.5%) patients had persistent postoperative dysphagia at 24 weeks and these patients were older, female, and less likely to drink alcohol. There was no difference in operative duration or dexamethasone administration. Patients with persistent dysphagia were significantly more likely to have C4-C5 included in the fusion construct (62.5% vs . 34.9%, P = 0.024) but there were no differences based on the inclusion of other levels. On multivariable regression, the inclusion of C3-C4 or C6-C7 was associated with more severe EAT-10 (β: 9.56, P = 0.016 and β: 8.15, P = 0.040) and Dysphagia Short Questionnaire (β: 4.44, P = 0.023 and (β: 4.27, P = 0.030) at 6 weeks. At 12 weeks, C3-C4 fusion was also independently associated with more severe dysphagia (EAT-10 β: 4.74, P = 0.024). CONCLUSION The location of prevertebral soft tissue swelling may impact the duration and severity of patient-reported dysphagia outcomes at up to 24 weeks postoperatively. In particular, the inclusion of C3-C4 and C4-C5 into the fusion may be associated with dysphagia severity.
Collapse
Affiliation(s)
- Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Aditya S Mazmudar
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tyler W Henry
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Darrel S Brodke
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, UT
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT
| | - Brian A Karamian
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, UT
| |
Collapse
|
2
|
Shen B, Gao Z, Wang B, Huang Y, Wu D. Relationship between intervertebral disc height and post operative dysphagia secondary to single-level anterior cervical discectomy and fusion- a retrospective study. BMC Musculoskelet Disord 2024; 25:369. [PMID: 38730401 PMCID: PMC11084003 DOI: 10.1186/s12891-024-07461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND One goal of Anterior Cervical Discectomy and Fusion (ACDF) is to restore the loss of intervertebral disc height (IDH) results from the degenerative process. However, the effects of IDH on postoperative dysphagia after ACDF remain unclear. METHODS Based on the results of a one-year telephone follow-up, A total of 217 consecutive patients after single-level ACDF were enrolled. They were divided into dysphagia and non-dysphagia groups. The age, BMI, operation time and blood loss of all patients were collected from the medical record system and compared between patients with and without dysphagia. Radiologically, IDH, spinous process distance (SP) of the operated segment, and C2-7 angle (C2-7 A) were measured preoperatively and postoperatively. The relationship between changes in these radiological parameters and the development of dysphagia was analyzed. RESULTS Sixty-three (29%) cases exhibited postoperative dysphagia. The mean changes in IDH, SP, and C2-7 A were 2.84 mm, -1.54 mm, and 4.82 degrees, respectively. Changes in IDH (P = 0.001) and changes in C2-7 A (P = 0.000) showed significant differences between dysphagia and non-dysphagia patients. Increased IDH and increased C2-7 A (P = 0.037 and 0.003, respectively) significantly and independently influenced the incidence of postoperative dysphagia. When the change in IDH was ≥ 3 mm, the chance of developing postoperative dysphagia for this patient was significantly greater. No significant relationship was observed between the change in spinous process distance (SP) and the incidence of dysphagia. The age, BMI, operation time and blood loss did not significantly influence the incidence of postoperative dysphagia. CONCLUSION The change in IDH could be regarded as a predictive factor for postoperative dysphagia after single-level ACDF.
Collapse
Affiliation(s)
- Beiduo Shen
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhiqiang Gao
- Department of Bone & Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Bijun Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yufeng Huang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| |
Collapse
|
3
|
Xie R, Liu J, Wang M, Dong Y, Mummaneni PV, Chou D. Realistic long-term dysphagia rates after anterior cervical discectomy with fusion: is there a correlation with postoperative sagittal alignment and lordosis at a minimum 2-year follow-up? J Neurosurg Spine 2022; 37:767-775. [PMID: 35901732 DOI: 10.3171/2022.4.spine211086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative dysphagia after anterior cervical discectomy and fusion (ACDF) has many contributing factors, and long-term data are sparse. The authors evaluated dysphagia after ACDF based on levels fused and cervical sagittal parameters. METHODS Patients who underwent ACDF between 2009 and 2018 at the University of California, San Francisco (UCSF), were retrospectively studied. Dysphagia was evaluated preoperatively, immediately postoperatively, and at last follow-up using the UCSF dysphagia score. Dysphagia was categorized as normal (level 7), mild (levels 5 and 6), moderate (levels 3 and 4), and severe (levels 1 and 2). The UCSF mild dysphagia score was further classified as "minimal dysphagia," while moderate and severe dysphagia were classified as "significant dysphagia." "Any dysphagia" included any dysphagia, regardless of grade. Cervical sagittal parameters were measured preoperatively, immediately postoperatively, and at last follow-up. RESULTS A total of 131 patients met inclusion criteria. The mean follow-up was 43.89 (24-142) months. Seventy-eight patients (59.5%) reported dysphagia immediately postoperatively, and 44 patients (33.6%) reported some dysphagia at last follow-up (p < 0.001). The rates of moderate dysphagia were 13.0% immediately postoperatively and 1.5% at the last follow-up (p < 0.001). Twenty-two patients (16.8%) had significant dysphagia immediately postoperatively, and 2 patients (1.5%) had significant dysphagia at last follow-up (p < 0.001). Patients with immediate postoperative dysphagia had less C2-7 preoperative lordosis (-9.35°) compared with patients without (-14.15°, p = 0.029), but there was no association between C2-7 lordosis and dysphagia at last follow-up (p = 0.232). The prevalence rates of immediate postoperative dysphagia and long-term dysphagia were 87.5% and 58.3% in ≥ 3-level ACDF; 64.0% and 40.0% in 2-level ACDF; and 43.9% and 17.5% in 1-level ACDF, respectively (p < 0.001). CONCLUSIONS The realistic incidence of any dysphagia after ACDF was 59.5% immediately postoperatively and 33.6% at the minimum 2-year follow-up, higher than previously published rates. However, most dysphagia was not severe. The number of fused levels was the most important risk factor for long-term dysphagia, but not for immediate postoperative dysphagia. Loss of preoperative C2-7 lordosis was associated with immediate postoperative dysphagia, but not long-term dysphagia. ACDF segmental lordosis and cervical sagittal vertical axis were not associated with long-term dysphagia in ACDF.
Collapse
Affiliation(s)
- Rong Xie
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Jinping Liu
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 3Department of Neurosurgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Minghao Wang
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Yinhui Dong
- 2Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| |
Collapse
|
4
|
Ziegler JP, Davidson K, Cooper RL, Garand KL, Nguyen SA, Yuen E, Martin-Harris B, O’Rourke AK. Characterization of dysphagia following anterior cervical spine surgery. ADVANCES IN COMMUNICATION AND SWALLOWING 2021; 24:55-62. [PMID: 36447810 PMCID: PMC9703912 DOI: 10.3233/acs-210034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Post-operative dysphagia is one of the most common complications of anterior cervical spine surgery (ACSS). OBJECTIVE Examine post-operative structural and physiologic swallowing changes in patients with dysphagia following ACSS as compared with healthy age and gender matched controls. METHODS Videofluoroscopic swallow studies of adults with dysphagia after ACSS were retrospectively reviewed. Seventy-five patients were divided into early (≤2 months) and late (> 2 months) post-surgical groups. Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS) scores, and pharyngeal wall thickness (PWT) metrics were compared. RESULTS Significant differences were identified for all parameters between the control and early post-operative group. MBSImP Pharyngeal Total (PT) scores were greater in the early group (Interquartile Range (IQR) = 9-14, median = 12) versus controls (4-7, 5, P < 0.001) and late group (0.75-7.25, 2, P < 0.001). The early group had significantly higher maximum PAS scores (IQR = 3-8, median = 7) than both the control group (1-2, 1, P < 0.001) and late post-operative group (1-1.25, 1, P < 0.001). PWT was significantly greater in the early (IQR = 11.12-17.33 mm, median = 14.32 mm) and late groups (5.31-13.01, 9.15 mm) than controls (3.81-5.41, 4.68 mm, P < 0.001). CONCLUSION Dysphagic complaints can persist more than two months following ACSS, but often do not correlate with validated physiologic swallowing dysfunction on VFSS. Future studies should focus on applications of newer technology to elucidate relevant deficits.
Collapse
Affiliation(s)
| | - Kate Davidson
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Erick Yuen
- Medical University of South Carolina, Charleston, SC, USA
| | | | | |
Collapse
|
5
|
Farber SH, Mauler DJ, Sagar S, Pacult MA, Walker CT, Bohl MA, Snyder LA, Chapple KM, Sonntag VKH, Uribe JS, Turner JD, Chang SW, Kakarla UK. Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion. J Neurosurg Spine 2021; 34:849-856. [PMID: 33799303 DOI: 10.3171/2020.10.spine201307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia. The overall risks of these complications and rates of dysphagia are not well studied for surgery on 4 or more segments. In this study, the authors evaluated their institution's perioperative experience with 4- and 5-level ACDFs. METHODS The authors retrospectively reviewed patients who underwent 4- or 5-level ACDF at their institution over a 6-year period (May 2013-May 2019). Patient demographics, perioperative complications, readmission rates, and swallowing outcomes were recorded. Outcomes were analyzed with a multivariate linear regression. RESULTS A total of 174 patients were included (167 had 4-level and 7 had 5-level ACDFs). The average age was 60.6 years, and 54.0% of patients (n = 94) were men. A corpectomy was performed in 12.6% of patients (n = 22). After surgery, 56.9% of patients (n = 99) experienced dysphagia. The percentage of patients with dysphagia decreased to 22.8% (37/162) at 30 days, 12.9% (17/132) at 90 days, and 6.3% (5/79) and 2.8% (1/36) at 1 and 2 years, respectively. Dysphagia was more likely at 90 days postoperatively in patients with gastroesophageal reflux (OR 4.4 [95% CI 1.5-12.8], p = 0.008), and the mean (± SD) lordosis change was greater in patients with dysphagia than those without at 90 days (19.8° ± 13.3° vs 9.1° ± 10.2°, p = 0.003). Dysphagia occurrence did not differ with operative implants, including graft and interbody type. The mean length of time to solid food intake was 2.4 ± 2.1 days. Patients treated with dexamethasone were more likely to achieve solid food intake prior to discharge (OR 4.0 [95% CI 1.5-10.6], p = 0.004). Postsurgery, 5.2% of patients (n = 9) required a feeding tube due to severe approach-related dysphagia. Other perioperative complication rates were uniformly low. Overall, 8.6% of patients (n = 15) returned to the emergency department within 30 days and 2.9% (n = 5) required readmission, whereas 1.1% (n = 2) required unplanned return to surgery within 30 days. CONCLUSIONS This is the largest series of patients undergoing 4- and 5-level ACDFs reported to date. This procedure was performed safely with minimal intraoperative complications. More than half of the patients experienced in-hospital dysphagia, which increased their overall length of stay, but dysphagia decreased over time.
Collapse
|
6
|
Abstract
STUDY DESIGN Prospective observational cohort study. OBJECTIVE To prospectively examine dysphagia after subaxial cervical spine surgery. SUMMARY OF BACKGROUND DATA Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery. METHODS This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined. RESULTS Thirty-two patients (16.8%) reported dysphagia before surgery. New dysphagia after surgery, defined as more than or equal to 1 grade worsening of the Bazaz score after surgery compared with the preoperative status, was observed in 38 patients (19.9%) at 6 months and 32 patients (16.8%) at 1 year. The incidence of new dysphagia at 1 year was 25.3% in the ADF group, 23.8% in the PDF group, and 6.0% in the LAMP group. Fusion surgery (ACDF or PDF) and increased CL after surgery were found as risk factors at 1 year in multivariate analysis; receiver operating characteristic analysis determined a postsurgical change in CL cutoff of 5°. CONCLUSION Fusion surgery and increased CL after surgery were risk factors for development of dysphagia after subaxial cervical spine surgery. Cervical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.Level of Evidence: 3.
Collapse
|
7
|
Echt M, Mikhail C, Girdler SJ, Cho SK. Anterior Reconstruction Techniques for Cervical Spine Deformity. Neurospine 2020; 17:534-542. [PMID: 33022158 PMCID: PMC7538358 DOI: 10.14245/ns.2040380.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 01/07/2023] Open
Abstract
Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential-including global or focal realignment in the sagittal and coronal planes. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. A detailed understanding of the patient's local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.
Collapse
Affiliation(s)
- Murray Echt
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christopher Mikhail
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven J. Girdler
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
8
|
Risk Factors and Assessment Using an Endoscopic Scoring System for Early and Persistent Dysphagia After Anterior Cervical Decompression and Fusion Surgery. Clin Spine Surg 2020; 33:E168-E173. [PMID: 32011353 DOI: 10.1097/bsd.0000000000000945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVES Preoperative and postoperative dysphagia was evaluated by an otolaryngology doctor and a speech-language-hearing therapist using the eating assessment tool (EAT-10) and Hyodo-Komagane scores. The objective was to achieve a more precise evaluation of the incidence and risk factors of early and persistent dysphagia after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Although numerous reports have explored the risk factors for dysphagia after ACDF, these factors remain controversial. The main reason for this situation is that the methods for evaluating dysphagia are not adequate or uniform. MATERIALS AND METHODS This study involved a retrospective 47 consecutive patients who had undergone ACDF and been followed up for at least 1 year. Sagittal alignment of the cervical spine was evaluated by a preoperative x-ray. Univariate and multivariate logistic regression analyses were performed to determine risk factors for transient or persistent dysphagia. RESULTS The study showed that 34% of patients developed dysphagia in the early postoperative period and that 25.5% of patients still had persistent dysphagia 1 year postoperatively. 8.5% of patients had already developed dysphagia preoperatively, with a significant positive correlation observed between preoperative and postoperative dysphagia.Aging and smoking were significant risk factors for transient dysphagia. A preoperative cervical kyphotic angle at the C3/C4, C4/C5 disk-level and change in the kyphotic angle at C4/C5 during surgery were significant risk factors of persistent dysphagia 1 year after surgery. CONCLUSIONS This is the first study to show dysphagia after anterior cervical spine surgery using the EAT-10 score and Hyodo-Komagane score with endoscopic evaluation. Aging and smoking were significant risk factors for transient dysphagia, while preoperative local kyphosis angles of C3-C4 and C4-C5 and change in the kyphotic angle at C4/C5 during surgery may be a key alignment of risk factors for postoperative persistent dysphagia. LEVEL OF EVIDENCE Level: III.
Collapse
|
9
|
Reinard KA, Cook DM, Zakaria HM, Basheer AM, Chang VW, Abdulhak MM. A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2068-77. [PMID: 26972082 DOI: 10.1007/s00586-016-4429-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery. METHODS A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia. RESULTS The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554). CONCLUSION Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.
Collapse
Affiliation(s)
- Kevin A Reinard
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Diana M Cook
- Division of Speech and Language Pathology, Henry Ford Hospital, Detroit, MI, USA
| | - Hesham M Zakaria
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Azam M Basheer
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Victor W Chang
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Muwaffak M Abdulhak
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| |
Collapse
|
10
|
Yao Q, Liang F, Xia Y, Jia C. A meta-analysis comparing total disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical degenerative diseases. Arch Orthop Trauma Surg 2016; 136:297-304. [PMID: 26411552 DOI: 10.1007/s00402-015-2337-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative diseases. METHODS We conducted a comprehensive search in the electronic databases including Pubmed, Medline, EBSCO, Springer, Ovid, CNKI and Cochrane Database of Systematic Reviews. Two independent reviewers performed the data extraction from archives. All data were performed with Review Manager 5.2 software. The relative risk (RR) and its 95% confidence interval (CI) were calculated for count data. Standardized mean difference (SMD) and corresponding 95% CI for continuous outcomes were pooled. RESULTS After applying inclusion and exclusion criteria, nine papers were included in meta-analyses. The results of the meta-analysis indicated better neurological success, better overall success, lower incidence of secondary surgical procedures and lower incidence of secondary surgical procedures in TDA group than in ACDF group. After removing a study with considerable weight, TDA group displayed lower incidence of dysphagia and dysphonia than ACDF group. CONCLUSION This meta-analysis revealed that the clinical outcomes of TDA are equivalent or superior to ACDF.
Collapse
Affiliation(s)
- Qiang Yao
- The First Orthopedics Department, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Feng Liang
- The First Orthopedics Department, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Yang Xia
- The First Orthopedics Department, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Changqing Jia
- The First Orthopedics Department, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China.
| |
Collapse
|