Avani S Vaishnav1, Philip Saville1, Steven McAnany2, Brittany Haws3, Kern Singh3, Sravisht Iyer2, Todd Albert2, Catherine Himo Gang1, Sheeraz A Qureshi4. 1. Hospital for Special Surgery, New York, NY, USA. 2. Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA. 3. Midwest Orthopedics at Rush, Hospital for Special Surgery, Chicago, IL, USA. 4. Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA. Electronic address: sheerazqureshimd@gmail.com.
Abstract
BACKGROUND CONTEXT: Dysphagia following anterior cervical discectomy and fusion (ACDF) is a common complication, the etiology of which has not been established. Given that one potential mechanism for dysphagia is local tissue edema, it is thought that a greater number of operative levels may result in higher dysphagia rates. However, prior reports comparing one-level to two-level ACDF have shown varying results. PURPOSE: To determine if there is a difference in dysphagia between one-level and two-level ACDF. STUDY DESIGN/ SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: Patients who underwent one- or two-level ACDF with a plate-graft construct by a single-surgeon at a high-volume academic medical center. OUTCOME MEASURES: Neck Disability Index, Visual Analog Scale for neck pain and arm pain, Short Form-12 physical and mental health components, and Swallowing Quality of Life (SWAL-QOL) Questionnaire. METHODS: Patient demographics, operative data, and patient-reported outcome measures (PROMs; Neck Disability Index, Visual Analog Scale, Short Form-12, and SWAL-QOL) of patients undergoing one- and two-level ACDF were compared using Fisher exact test for categorical variables and Student's t test for continuous variables. Regression analyses were conducted to identify factors associated with 6- and 12-week SWAL-QOL scores in order to determine whether the number of surgical levels impacts these outcomes. RESULTS: Fifty-eight patients (22 one-level and 36 two-level ACDF) were included. Patients undergoing two-level fusions were older (54.17+8.67 vs 48.06+10.68 years, p=.02) and had longer operative times (69.08+10.51 vs 53.5+14.35 minutes, p<.0001). There were no other significant differences in demographics or operative data. Both groups showed a statistically significant improvement in PROMs from preoperatively to 12 weeks. There was no difference in PROMs or dysphagia rates between groups at any time-point. Younger age (p=.023), male sex (p=.021), longer operative times (p=.068), and worse preoperative SWAL-QOL (p<.0001) were associated with dysphagia at 6 weeks. Preoperative SWAL-QOL was the only variable associated with dysphagia at 12 weeks (p=.003). Operative time of >61.5 minutes had a sensitivity and specificity of 62.1% for worse dysphagia scores at 6 weeks compared with baseline. CONCLUSIONS: The results of our study indicate that there is no difference in the degree of postoperative dysphagia in one- versus two-level ACDF. However, other variables associated with increased postoperative dysphagia in our population included younger age, male sex, procedural time >61.5 minutes, and worse preoperative dysphagia. Larger studies are required to confirm these findings and identify additional risk factors for postoperative dysphagia.
BACKGROUND CONTEXT: Dysphagia following anterior cervical discectomy and fusion (ACDF) is a common complication, the etiology of which has not been established. Given that one potential mechanism for dysphagia is local tissue edema, it is thought that a greater number of operative levels may result in higher dysphagia rates. However, prior reports comparing one-level to two-level ACDF have shown varying results. PURPOSE: To determine if there is a difference in dysphagia between one-level and two-level ACDF. STUDY DESIGN/ SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: Patients who underwent one- or two-level ACDF with a plate-graft construct by a single-surgeon at a high-volume academic medical center. OUTCOME MEASURES: Neck Disability Index, Visual Analog Scale for neck pain and arm pain, Short Form-12 physical and mental health components, and Swallowing Quality of Life (SWAL-QOL) Questionnaire. METHODS:Patient demographics, operative data, and patient-reported outcome measures (PROMs; Neck Disability Index, Visual Analog Scale, Short Form-12, and SWAL-QOL) of patients undergoing one- and two-level ACDF were compared using Fisher exact test for categorical variables and Student's t test for continuous variables. Regression analyses were conducted to identify factors associated with 6- and 12-week SWAL-QOL scores in order to determine whether the number of surgical levels impacts these outcomes. RESULTS: Fifty-eight patients (22 one-level and 36 two-level ACDF) were included. Patients undergoing two-level fusions were older (54.17+8.67 vs 48.06+10.68 years, p=.02) and had longer operative times (69.08+10.51 vs 53.5+14.35 minutes, p<.0001). There were no other significant differences in demographics or operative data. Both groups showed a statistically significant improvement in PROMs from preoperatively to 12 weeks. There was no difference in PROMs or dysphagia rates between groups at any time-point. Younger age (p=.023), male sex (p=.021), longer operative times (p=.068), and worse preoperative SWAL-QOL (p<.0001) were associated with dysphagia at 6 weeks. Preoperative SWAL-QOL was the only variable associated with dysphagia at 12 weeks (p=.003). Operative time of >61.5 minutes had a sensitivity and specificity of 62.1% for worse dysphagia scores at 6 weeks compared with baseline. CONCLUSIONS: The results of our study indicate that there is no difference in the degree of postoperative dysphagia in one- versus two-level ACDF. However, other variables associated with increased postoperative dysphagia in our population included younger age, male sex, procedural time >61.5 minutes, and worse preoperative dysphagia. Larger studies are required to confirm these findings and identify additional risk factors for postoperative dysphagia.
Authors: Ichiro Okano; Courtney Ortiz Miller; Stephan N Salzmann; Yushi Hoshino; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Alexander P Hughes Journal: Clin Orthop Relat Res Date: 2020-10 Impact factor: 4.755