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Arnautovic A, Mijares J, Begagić E, Ahmetspahić A, Pojskić M. Four-level ACDF surgical series 2000-2022: a systematic review of clinical and radiological outcomes and complications. Br J Neurosurg 2024:1-12. [PMID: 38606493 DOI: 10.1080/02688697.2024.2337020] [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: 01/11/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The primary objective of this investigation is to systematically scrutinize extant surgical studies delineating Four-Level Anterior Cervical Discectomy and Fusion (4L ACDF), with a specific emphasis on elucidating reported surgical indications, clinical and radiological outcomes, fusion rates, lordosis correction, and the spectrum of complication rates. METHODS The literature review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing the MEDLINE (PubMed), Embase, and Scopus databases. This analysis encompasses studies implementing the 4L ACDF procedure, with detailed extraction of pertinent data pertaining to surgical methodologies, types of employed interbody cages, clinical and radiological endpoints, rates of fusion, and the incidence of complications. RESULTS Among the 15 studies satisfying inclusion criteria, a marginal increment in the year 2022 (21.4%) was discerned, with a preponderance of study representation emanating from China (35.7%) and the United States (28.6%). 50% of the studies were single-surgeon studies. Concerning follow-up, studies exhibited variability, with 42.9% concentrating on periods of five years or less, and an equivalent proportion extending beyond this timeframe. Across the amalgamated cohort of 2457 patients, males constituted 51.6%, manifesting a mean age range of 52.2-61.3 years. Indications for surgery included radiculopathy (26.9%) and myelopathy (46.9%), with a predilection for involvement at C3-7 (24.9%). Meta-analysis yielded an overall complication rate of 16.258% (CI 95%: 14.823%-17.772%). Dysphagia (4.563%), haematoma (1.525%), hoarseness (0.205%), C5 palsy (0.176%) were the most prevalent complications of 4L ACDF. Fusion rates ranging from 41.3% to 94% were documented. CONCLUSION The 4L ACDF is commonly performed to address mylopathy and radiculopathy. While the surgery carries a complication rate of around 16%, its effectiveness in achieving bone fusion can vary considerably.
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Affiliation(s)
- Alisa Arnautovic
- George Washington University School of Medicine, Washington, DC, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Mijares
- George Washington University School of Medicine, Washington, DC, USA
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Adi Ahmetspahić
- Department of Neurosurgery, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- School of Medicine, Josip Juraj Strossmayr University, Osijek, Croatia
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Frazure M, Greene CL, Iceman KE, Howland DR, Pitts T. Dysphagia as a Missing Link Between Post-surgical- and Opioid-Related Pneumonia. Lung 2024; 202:179-187. [PMID: 38538927 PMCID: PMC11135177 DOI: 10.1007/s00408-024-00672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE Postoperative pneumonia remains a common complication of surgery, despite increased attention. The purpose of our study was to determine the effects of routine surgery and post-surgical opioid administration on airway protection risk. METHODS Eight healthy adult cats were evaluated to determine changes in airway protection status and for evidence of dysphagia in two experiments. (1) In four female cats, airway protection status was tracked following routine abdominal surgery (spay surgery) plus low-dose opioid administration (buprenorphine 0.015 mg/kg, IM, q8-12 h; n = 5). (2) Using a cross-over design, four naive cats (2 male, 2 female) were treated with moderate-dose (0.02 mg/kg) or high-dose (0.04 mg/kg) buprenorphine (IM, q8-12 h; n = 5). RESULTS Airway protection was significantly affected in both experiments, but the most severe deficits occurred post-surgically as 75% of the animals exhibited silent aspiration. CONCLUSION Oropharyngeal swallow is impaired by the partial mu-opioid receptor agonist buprenorphine, most remarkably in the postoperative setting. These findings have implications for the prevention and management of aspiration pneumonia in vulnerable populations.
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Affiliation(s)
- Michael Frazure
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, USA
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, College of Medicine, University of Louisville, Louisville, KY, USA
| | - Clinton L Greene
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA
| | - Kimberly E Iceman
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA
| | - Dena R Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, College of Medicine, University of Louisville, Louisville, KY, USA
| | - Teresa Pitts
- Department of Speech Language and Hearing Sciences and Dalton Cardiovascular Center, University of Missouri, 701 S Fifth St, Columbia, MO, 65203, USA.
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Yu C, Chunmei L, Caiping S. A multicenter cross-sectional survey of the knowledge, attitude, and behaviour of nurses regarding dysphagia after anterior cervical spine surgery: a prospective multicentre study. BMC Nurs 2024; 23:74. [PMID: 38281978 PMCID: PMC10823728 DOI: 10.1186/s12912-023-01690-2] [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: 11/22/2023] [Accepted: 12/25/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The incidence of dysphagia after anterior cervical spine surgery is high, which directly affects the quality of life of patients after surgery. The knowledge, attitude, and behavior of nurses can affect the identification and management of patients after anterior cervical spine surgery. Therefore, we need a survey to understand the current status of nurses' knowledge, attitude, and behavior towards dysphagia after anterior cervical spine surgery. OBJECTIVE To investigate the knowledge, attitude, and behaviour of orthopaedic nurses towards patients with dysphagia after anterior cervical spine surgery and provide recommendations for management and intervention. METHOD An online cross-sectional survey was conducted between March and June 2023, which among 894 orthopaedic nurses from 36 tertiary hospitals in Chongqing using a questionnaire. The questionnaire included general information and knowledge, attitudes, and behaviours related to the management of dysphagia after anterior cervical surgery. RESULTS The orthopaedic nurses' mean score for dysphagia-related knowledge was 16.1 ± 3.640 (out of a total score of 30). The orthopaedic nurses' mean score for dysphagia-related attitude was 32.5 ± 4.623 (out of a total score of 40). The orthopaedic nurses' mean score for dysphagia-related behaviour was 43.6 ± 11.513 (out of a total score of 60). The results of statistical analysis showed that the dysphagia after anterior cervical spine surgery -related knowledge scores differed significantly among the nurses according to, education level, and training (P < 0.05). Correlation analysis showed that there was a positive correlation between the knowledge, attitude, and behaviour scores of neurological nurses and swallowing disorders after anterior cervical surgery (P < 0.05). CONCLUSION Targeted knowledge and skills training should be carried out to improve the rules and regulations for dysphagia after anterior cervical spine surgery. Multidisciplinary team cooperation is needed, and dietary service processes and management standards should be improved to improve the management ability of orthopaedic nurses for dysphagia after anterior cervical spine surgery.
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Affiliation(s)
- Chen Yu
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Luo Chunmei
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Song Caiping
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China.
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Chen Y, Zhu J, Zhu F, Feng C, Luo C, Song C. Predictive Factors for Dysphagia After Anterior Cervical Spine Surgery: A Prospective Multicenter Study. World Neurosurg 2023; 178:e533-e539. [PMID: 37516144 DOI: 10.1016/j.wneu.2023.07.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To identify the incidence and predictors of postoperative dysphagia in patients who undergo anterior cervical spine surgery (ACSS) by utilizing the Eating Assessment Tool (EAT-10). METHODS A multicenter prospective study was undertaken at three hospitals to evaluate patients undergoing ACSS between January 2021 and January 2023. Included patients were aged 18-80 years and were undergoing primary or revision ACSS. Dysphagia was assessed using the validated EAT-10 questionnaire. Patients with dysphagia were included in the observation group, and those without dysphagia were included in the control group. RESULTS Of the 343 patients enrolled, 50 patients (14.6%) had EAT-10 scores of 3 or more at the 6-month follow-up. In the univariate analysis, patients with dysphagia at 7 days had a longer operative time, were current smokers, had involvement of vertebral bodies at C4 and above, and underwent intraoperative neurophysiological monitoring. Patients with dysphagia at 6 months had involvement of vertebral bodies at C4 and above and underwent intraoperative neurophysiological monitoring. In the multivariate analysis to determine associations with prolonged dysphagia, only the involvement of vertebral bodies at C4 and above (odds ratio 3.883, 95% confidence interval 1.847-8.165, P = 0.001) and intraoperative neurophysiological monitoring (odds ratio 0.273, 95% confidence interval 0.080-0.931, P = 0.038) remained significant. CONCLUSIONS Dysphagia is common after ACSS, affecting more than 67.5% of patients at 7 days postoperatively, but over time, the incidence of dysphagia gradually decreases. Involvement of the vertebral bodies at C4 and above is a risk factor for dysphagia after ACSS, and intraoperative neurophysiological monitoring is a protective factor.
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Affiliation(s)
- Yu Chen
- Army Medical University, Chongqing, China
| | - Jingzhen Zhu
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Fengzhao Zhu
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chunmei Luo
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Caiping Song
- Department of Office of the Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Ma Y, Sang P, Chen B, Li J, Bei D. The role of prevertebral soft tissue swelling in dysphagia after anterior cervical corpectomy fusion: change trends and risk factors. BMC Musculoskelet Disord 2023; 24:720. [PMID: 37689657 PMCID: PMC10492395 DOI: 10.1186/s12891-023-06843-7] [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: 05/14/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the change trends of prevertebral soft tissue swelling (PSTS) for anterior cervical corpectomy fusion(ACCF) and to evaluate the risk factors of PSTS for postoperative dysphagia. METHODS There were 309 patients with degenerative cervical diseases who were treated with ACCF from November 2015 and September 2019 in our hospital. According to the symptom of swallowing function after ACCF, those were divided into the dysphagia group and the normal-swallowing function group. Cervical computed tomography(CT) was analyzed, and radiological evaluation of the prevertebral soft tissue was measured between the antero-inferior corner of each vertebral body and the air shadow of the airway through CT mid-sagittal slice images before operation and after operation(one week, one month, eight months and twelve months). RESULTS The incidence of dysphagia after ACCF was 41.1%. 120 of 127(94.5%) patients had dysphagia disappeared at the 8 months after ACCF, and all disappeared at the 12 months. In both groups, PSTS would be biggest at 1 week postoperatively comparing to the preoperative, and then get smaller from 1 week to 12 months postoperatively (p < 0.05). After 12 months of operation, the PSTS of all cervical spinal levels would get equal to the preoperative size in the normal-swallowing function group, while the PSTS in dysphagia group would get equal only in C5-7 levels. The PSTS of preoperative C6 level and postoperative C2 level were more closely related to the present of postoperative dysphagia (OR: 9.403, 95%CI: 2.344-37.719, OR: 3.187, 95%CI: 1.78-5.705). It was more important to predict postoperative dysphagia using the value of PSTS at preoperative C6 level and postoperative C2 level, with the cutoff threshold for the PSTS of preoperative C6 level ≦1.51 cm and postoperative C2 level ≦1.3915 cm, which could get sensitivity & specificity 66.929% and 61.54%, 77.17% and 64.29%, respectively. CONCLUSION Our study showed that the increasing of the PSTS after ACCF should be considered as a risk factor of dysphagia after surgery. With the recovery of PSTS over time, the incidence of postoperative dysphagia decreases. The PSTS of preoperative C6 level and and postoperative C2 level should play an important part in predicting the risk of postoperative dysphagia.
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Affiliation(s)
- Yanyan Ma
- Department of Gastroenterology, Lihuili Hospital of Ningbo Medical Center, Ningbo, Zhejiang, PR China
| | - Peiming Sang
- Department of Orthopedic Surgery, Lihuili Hospital of Ningbo Medical Center, #57, Xingning Road, Yinzhou District, Ningbo, Zhejiang, PR China.
| | - Binhui Chen
- Department of Orthopedic Surgery, Lihuili Hospital of Ningbo Medical Center, #57, Xingning Road, Yinzhou District, Ningbo, Zhejiang, PR China
| | - Jie Li
- Department of Orthopedic Surgery, Lihuili Hospital of Ningbo Medical Center, #57, Xingning Road, Yinzhou District, Ningbo, Zhejiang, PR China
| | - Dikai Bei
- Department of Orthopedic Surgery, Lihuili Hospital of Ningbo Medical Center, #57, Xingning Road, Yinzhou District, Ningbo, Zhejiang, PR China
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Mazmudar A, Paziuk T, Tran KS, Henry T, Oh S, Purtill C, Habbal D, Yalla G, Harrill Q, Sherrod B, Bisson E, Brodke D, Kepler C, Schroeder G, Vaccaro A, Hilibrand A, Rihn JA. Evaluating Dysphagia Duration and Severity After ACDF in Patients With Underlying Dysphagia - A Prospective, Multicenter Study. Global Spine J 2023:21925682231201249. [PMID: 37671756 DOI: 10.1177/21925682231201249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
STUDY DESIGN Prospective Cohort Study. OBJECTIVES The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions. METHODS After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these dysphagia surveys were repeated immediately postoperatively, at two weeks and again at six, 12, and 24 weeks postoperatively. Patients were stratified into three subgroups based on dysphagia status preoperatively and immediately postoperatively and compared using ANOVA tests or Kruskal-Wallis tests for continuous variables and Pearson chi-square analysis or Fisher's Exact test for categorical variables. RESULTS A total of 168 patients (23 with preoperative dysphagia, 145 without preoperative dysphagia) met study criteria and were enrolled in the study. Patients with preoperative dysphagia had less frequent alcohol consumption (23.8% vs 53.7%, P = .0210), and higher rates of dysphagia at 2-weeks (77.8% vs 38.7%, P = .004) and 24-weeks (43.8% vs 14.8%, P = .010) postoperatively. These patients also had higher severity scores for dysphagia on the Bazaz (P = .001), DSQ (P = .012), EAT10 (P = .022) questionnaires at the 2-week follow-up period, higher DSQ scores (P = .036) at the 6-week follow-up period, higher EAT-10 scores (P = .009) at the 12-week follow-up period, and higher Bazaz (P = .001), DSQ (P = .002), and EAT-10 (P = .005) scores at the 24-week follow-up period. There were no differences in demographic, medical history, surgical variables, rates of ENT consultation, length of stay, or other in-hospital events between groups. CONCLUSIONS Patients undergoing ACDF who had preoperative dysphagia have prolonged postoperative dysphagia and greater dysphagia severity. Surgeons should be aware of the risk of prolonged dysphagia severity that may persist past 24 weeks after surgery when discussing clinical decisions with patients.
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Affiliation(s)
- Aditya Mazmudar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Khoa S Tran
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Tyler Henry
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Samuel Oh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Habbal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Goutham Yalla
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Quinlin Harrill
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Brandon Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Erica Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Darrel Brodke
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
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Wang Z, Zhu X, Wang Z, Zhu R, Chen G, Gao M, Chen K, Yang H. Zero-P and ROI-C implants versus traditional titanium plate with cage to treat cervical spondylotic myelopathy: clinical and radiological results with 5 years of follow-up. BMC Musculoskelet Disord 2023; 24:539. [PMID: 37391741 DOI: 10.1186/s12891-023-06657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is the gold standard for treating cervical spondylotic myelopathy (CSM). While implanting plates in ACDF may increase the risk of complications. Zero-P and ROI-C implants have been gradually applied for CSM. METHODS 150 patients with CSM were retrospectively analyzed from January 2013 to July 2016. Group A consisted of 56 patients who received traditional titanium plates with cage. 94 patients underwent ACDF using zero-profile implants and were divided into 50 patients with the Zero-P device (Group B) and 44 with the ROI-C device (Group C). Related indicators were measured and compared. The clinical outcomes were evaluated by JOA, VAS, and NDI scores. RESULTS Compared with group A, group B and C had a less blood loss and shorter operation time. The JOA and VAS scores improved significantly from pre-operative to 3 months postoperative and last follow-up in three groups. The cervical physiological curvature and segmental lordosis at final follow-up were higher than that of pre-operation (p < 0.05). Dysphagia rate, adjacent level degeneration rate, and Osteophyma rate was the highest in group A (p < 0.05). The bone graft fusion was achieved at the final follow-up in three groups. There were no statistical significance in fusion rate and subsidence rate among the three groups. CONCLUSIONS ACDF with Zero-P or ROI-C implants can also obtain satisfactory clinical outcomes compared to traditional titanium plate with cage after 5 years follow-up. The zero-profile implant devices carry a simple operation, short operation time, less intraoperation blood loss, and incidence of dysphagia.
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Affiliation(s)
- Zhidong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Xu Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Zhenheng Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Ruofu Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Guangdong Chen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Maofeng Gao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China
| | - Kangwu Chen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China.
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, China.
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Molfenter SM, Amin MR, Balou M, Herzberg EG, Frempong-Boadu A. A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: the need for a paradigm shift. 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 2023; 32:969-976. [PMID: 36625955 PMCID: PMC10805127 DOI: 10.1007/s00586-022-07515-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Dysphagia is the most commonly reported complication of annterior cervical discectomy and fusion (ACDF) surgery. However, the incidence of dysphagia post-ACDF varies widely-partly attributable to differing outcome measures used to capture dysphagia. Our objective was to conduct a scoping review of the literature to quantify which dysphagia outcome measures have been employed post-ACDF and examine trends by study design, year, and location. METHODS After removing duplicates, 2396 abstracts were screened for inclusion. A total of 480 studies were eligible for full-text review. After applying exclusion criteria, data was extracted from 280 studies. We extracted the dysphagia outcome measure(s), study design (prospective vs retrospective), year, and location (country). Approximately 10% of studies were repeated for intra-rater agreement. RESULTS In total, 317 dysphagia outcome measures were reported in 280 studies (primarily retrospective-63%). The largest proportion of outcome measures were categorized as "unvalidated patient-reported outcome measures" (46%), largely driven by use of the popular Bazaz scale. The next most common categories were "insufficient detail" and "validated patient-reported outcome measures" (both 16%) followed by "chart review/database" (13%) and instrumental assessment (7%). Studies examining dysphagia post-ACDF steadily increased over the years and the use of validated measures increased in the past 10 years. CONCLUSIONS This scoping review of the literature highlights that nearly half of the ACDF dysphagia literature relies on unvalidated patient-reported outcome measures. The current understanding of the mechanism, timeline, and presentation of dysphagia post-ACDF are likely limited due to the metrics that are most commonly reported in the literature.
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Affiliation(s)
- Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, Room 622, New York, NY, 10012, USA.
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA.
| | - Milan R Amin
- Department of Otolaryngology, Head & Neck Surgery, NYU Langone Health, New York, NY, USA
| | - Matina Balou
- Department of Otolaryngology, Head & Neck Surgery, NYU Langone Health, New York, NY, USA
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Alentado VJ, Bisson EF, Potts EA. Dysphagia after cervical spine surgery: a review of risk factors and preventative measures. J Neurosurg Spine 2023; 38:382-388. [PMID: 36681963 DOI: 10.3171/2022.11.spine221247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Vincent J Alentado
- 1Department of Neurosurgery, Indiana University, Indianapolis, Indiana
- 2Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 3Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Eric A Potts
- 2Goodman Campbell Brain and Spine, Carmel, Indiana
- 4St. Vincent Health, Indianapolis, Indiana
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10
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Nachalon Y. Anterior cervical spine surgery and dysphagia. Curr Opin Otolaryngol Head Neck Surg 2022; 30:417-421. [PMID: 36004798 DOI: 10.1097/moo.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current evidence regarding dysphagia in anterior cervical spine surgeries (ACSS) and to present recent advances in evaluation and surgical technique. RECENT FINDINGS Various risk factors for dysphagia have been identified, and they include female sex, smoking history, prior surgery and cervical lordotic angle. EAT-10 is a validated tool for the assessment of individuals with dysphagia post-ACSS. Local intraoperative corticosteroid application significantly reduced the incidence and magnitude of dysphagia in four out of five studies that were reviewed. Individuals who had undergone cervical disc replacement (CDR) and revision surgery by a zero-profile anchored spacer (ROI-C) device experienced less dysphagia than those who had anterior cervical discectomy with fusion (ACDF). Videofluoroscopic swallow study (VFSS) after ACSS demonstrated pharyngeal weakness and increased posterior pharyngeal wall thickness, while no other abnormality was found. SUMMARY Different technique variations can reduce dysphagia severity in individuals undergoing ACSS. Surgeons are encouraged to continue performing randomized control studies to assist in choosing the most favourable technique for the patient.
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Affiliation(s)
- Yuval Nachalon
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tsalimas G, Evangelopoulos DS, Benetos IS, Pneumaticos S. Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion. Cureus 2022; 14:e26888. [PMID: 35978748 PMCID: PMC9375980 DOI: 10.7759/cureus.26888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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