BACKGROUND CONTEXT: Dysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia. PURPOSE: To determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Forty-three patients. OUTCOME MEASURES: Validated dysphagia questionnaire, lateral cervical spine radiographs. METHODS: Patients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling. RESULTS: Forty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point. CONCLUSIONS: There is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.
BACKGROUND CONTEXT: Dysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia. PURPOSE: To determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Forty-three patients. OUTCOME MEASURES: Validated dysphagia questionnaire, lateral cervical spine radiographs. METHODS:Patients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling. RESULTS: Forty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point. CONCLUSIONS: There is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.
Authors: Jun Dong; Meng Lu; Teng Lu; Baobao Liang; Junkui Xu; Jun Zhou; Hongjun Lv; Jie Qin; Xuan Cai; Sihua Huang; Haopeng Li; Dong Wang; Xijing He Journal: PLoS One Date: 2015-06-11 Impact factor: 3.240
Authors: Yushi Hoshino; Ichiro Okano; Erika Chiapparelli; Stephan N Salzmann; Courtney Ortiz Miller; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Alexander P Hughes Journal: Eur Spine J Date: 2020-06-07 Impact factor: 3.134
Authors: Abidemi S Adenikinju; Sameer H Halani; Rima S Rindler; Matthew F Gary; Keith W Michael; Faiz U Ahmad Journal: Int J Spine Surg Date: 2017-03-06