Lawrence J Oh1, Sam Ong2, Sherief Ghozy3,4, Adam A Dmytriw5, Jeffrey Zuccato5, Ralph Mobbs1,6,7, Kevin Phan1,6, Mahmoud Dibas8, Harrison Faulkner1. 1. Faculty of Medicine, University of New South Wales, Sydney, Australia. 2. Department of Surgery, Bedford Hospital South Wing, Bedford, UK. 3. Faculty of Medicine, Mansoura University, Mansoura, Egypt. 4. Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt. 5. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 6. Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia. 7. Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia. 8. Sulaiman Al Rajhi Colleges, College of Medicine, Al Bukayriyah, Saudi Arabia.
Abstract
BACKGROUND: To conduct a meta-analysis to assess dysphagia complicating single-level and multiple-level (≥2) anterior cervical discectomy and fusion (ACDF) surgery. METHODS: Electronic searches were performed using four electronic databases from their inception to December 2017. Relevant studies reporting the rate of dysphagia as an endpoint for patients undergoing ACDF for degenerative disease, myelopathy, cervical canal stenosis or ossification of the posterior longitudinal ligament were identified according to prior inclusion and exclusion criteria. Statistical analysis was performed using a fixed effect model. P-scores were used to rank the levels of ACDF based on the rate of dysphagia. I2 was used to explore heterogeneity. RESULTS: Ten studies were identified and included in the systematic review and meta-analysis, with a total of 4,018 patients identified; 2,362 patients underwent single-level ACDF, while 1,656 underwent multiple level (≥2 ACDF). The mean age ranged from 49.45 to 57.77 years. Mean follow-up time ranged from 2 days to 27.3 months. Overall, meta-analysis demonstrated a statistically significant higher dysphagia rate for multiple-level ACDF (6.6%) than for single-level ACDF (4%) (P heterogeneity =0.151, OR =1.42, 95% CI: 1.05-1.91, I2=32%). CONCLUSIONS: Dysphagia is a relatively common complication in the early postoperative period following ACDF and may cause patients significant discomfort and distress. This meta-analysis demonstrates a higher rate of dysphagia with multiple-level ACDF than with single-level ACDF at a period of 12-24 months. 2020 Journal of Spine Surgery. All rights reserved.
BACKGROUND: To conduct a meta-analysis to assess dysphagia complicating single-level and multiple-level (≥2) anterior cervical discectomy and fusion (ACDF) surgery. METHODS: Electronic searches were performed using four electronic databases from their inception to December 2017. Relevant studies reporting the rate of dysphagia as an endpoint for patients undergoing ACDF for degenerative disease, myelopathy, cervical canal stenosis or ossification of the posterior longitudinal ligament were identified according to prior inclusion and exclusion criteria. Statistical analysis was performed using a fixed effect model. P-scores were used to rank the levels of ACDF based on the rate of dysphagia. I2 was used to explore heterogeneity. RESULTS: Ten studies were identified and included in the systematic review and meta-analysis, with a total of 4,018 patients identified; 2,362 patients underwent single-level ACDF, while 1,656 underwent multiple level (≥2 ACDF). The mean age ranged from 49.45 to 57.77 years. Mean follow-up time ranged from 2 days to 27.3 months. Overall, meta-analysis demonstrated a statistically significant higher dysphagia rate for multiple-level ACDF (6.6%) than for single-level ACDF (4%) (P heterogeneity =0.151, OR =1.42, 95% CI: 1.05-1.91, I2=32%). CONCLUSIONS: Dysphagia is a relatively common complication in the early postoperative period following ACDF and may cause patients significant discomfort and distress. This meta-analysis demonstrates a higher rate of dysphagia with multiple-level ACDF than with single-level ACDF at a period of 12-24 months. 2020 Journal of Spine Surgery. All rights reserved.
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