Narihito Nagoshi1, Lindsay Tetreault, Hiroaki Nakashima, Paul M Arnold, Giuseppe Barbagallo, Branko Kopjar, Michael G Fehlings. 1. 1Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 2Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan 3Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan 4University of Kansas, Kansas City, Kansas 5Department of Neurosurgery, University Hospital Catania, Catania, Italy 6Department of Health Services, University of Washington, Seattle, Washington.
Abstract
BACKGROUND: Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion. METHODS: Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors. RESULTS: The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-term improvements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia. CONCLUSIONS: The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-term follow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion. METHODS: Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors. RESULTS: The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-term improvements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia. CONCLUSIONS: The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-term follow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Bryce A Basques; Philip K Louie; Jeremy Mormol; Jannat M Khan; Kamran Movassaghi; Justin C Paul; Arya Varthi; Edward J Goldberg; Howard S An Journal: Eur Spine J Date: 2018-06-26 Impact factor: 3.134
Authors: Jeffery Head; George Rymarczuk; Geoffrey Stricsek; Lohit Velagapudi; Christopher Maulucci; Christian Hoelscher; James Harrop Journal: Neurospine Date: 2019-09-30
Authors: Abhishek Kannan; Silvia Minardi; David J Ellenbogen; Mitchell J Hallman; Allison C Greene; Jonathan T Yamaguchi; Mark A Plantz; Soyoen Jeong; Kennedy C Sana; Vivek Shah; Chawon Yun; Erin L Hsu; Wellington K Hsu Journal: JOR Spine Date: 2021-12-13