Departments of Orthopaedic Surgery.
Otorhinolaryngology.
Clin Spine Surg. 2020 May;33(4):E168-E173. doi: 10.1097/BSD.0000000000000945.
Prospective study.
Preoperative and postoperative dysphagia was evaluated by an otolaryngology doctor and a speech-language-hearing therapist using the eating assessment tool (EAT-10) and Hyodo-Komagane scores. The objective was to achieve a more precise evaluation of the incidence and risk factors of early and persistent dysphagia after anterior cervical discectomy and fusion (ACDF).
Although numerous reports have explored the risk factors for dysphagia after ACDF, these factors remain controversial. The main reason for this situation is that the methods for evaluating dysphagia are not adequate or uniform.
This study involved a retrospective 47 consecutive patients who had undergone ACDF and been followed up for at least 1 year. Sagittal alignment of the cervical spine was evaluated by a preoperative x-ray. Univariate and multivariate logistic regression analyses were performed to determine risk factors for transient or persistent dysphagia.
The study showed that 34% of patients developed dysphagia in the early postoperative period and that 25.5% of patients still had persistent dysphagia 1 year postoperatively. 8.5% of patients had already developed dysphagia preoperatively, with a significant positive correlation observed between preoperative and postoperative dysphagia.Aging and smoking were significant risk factors for transient dysphagia. A preoperative cervical kyphotic angle at the C3/C4, C4/C5 disk-level and change in the kyphotic angle at C4/C5 during surgery were significant risk factors of persistent dysphagia 1 year after surgery.
This is the first study to show dysphagia after anterior cervical spine surgery using the EAT-10 score and Hyodo-Komagane score with endoscopic evaluation. Aging and smoking were significant risk factors for transient dysphagia, while preoperative local kyphosis angles of C3-C4 and C4-C5 and change in the kyphotic angle at C4/C5 during surgery may be a key alignment of risk factors for postoperative persistent dysphagia.
Level: III.
前瞻性研究。
通过耳鼻喉科医生和言语语言治疗师使用饮食评估工具（EAT-10）和 Hyodo-Komagane 评分评估术前和术后吞咽困难。目的是更精确地评估颈椎前路椎间盘切除融合术（ACDF）后早期和持续性吞咽困难的发生率和危险因素。
尽管有许多报道探讨了 ACDF 后吞咽困难的危险因素，但这些因素仍存在争议。造成这种情况的主要原因是评估吞咽困难的方法不充分或不统一。
本研究回顾性分析了 47 例连续接受 ACDF 并至少随访 1 年的患者。颈椎矢状位排列通过术前 X 线评估。采用单变量和多变量逻辑回归分析确定暂时性或持续性吞咽困难的危险因素。
研究表明，34%的患者在术后早期出现吞咽困难，25.5%的患者在术后 1 年仍存在持续性吞咽困难。8.5%的患者术前已出现吞咽困难，术前和术后吞咽困难呈显著正相关。年龄和吸烟是暂时性吞咽困难的显著危险因素。术前 C3/C4、C4/C5 椎间盘水平颈椎后凸角和手术中 C4/C5 后凸角变化是术后 1 年持续性吞咽困难的显著危险因素。
这是第一项使用 EAT-10 评分和 Hyodo-Komagane 评分结合内镜评估颈椎前路手术后吞咽困难的研究。年龄和吸烟是暂时性吞咽困难的显著危险因素，而术前 C3-C4 和 C4-C5 局部后凸角以及手术中 C4/C5 后凸角的变化可能是术后持续性吞咽困难的关键危险因素。
III 级。
