Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan.
Spine (Phila Pa 1976). 2024 Jan 15;49(2):81-89. doi: 10.1097/BRS.0000000000004815. Epub 2023 Sep 4.
Retrospective review of a prospectively collected registry.
The purpose of the present study was to investigate the impact of frailty and radiographical parameters on postoperative dysphagia after anterior cervical spine surgery (ACSS).
There is a growing body of literature indicating an association between frailty and increased postoperative complications following various surgeries. However, few studies have investigated the relationship between frailty and postoperative dysphagia after anterior cervical spine surgery.
Patients who underwent anterior cervical spine surgery for the treatment of degenerative cervical pathology were included. Frailty and dysphagia were assessed by the modified Frailty Index-11 (mFI-11) and Eat Assessment Tool 10 (EAT-10), respectively. We also collected clinical demographics and cervical alignment parameters previously reported as risk factors for postoperative dysphagia. Multivariable logistic regression was performed to identify the odds ratio (OR) of postoperative dysphagia at early (2-6 weeks) and late postoperative time points (1-2 years).
Ninety-five patients who underwent ACSS were included in the study. Postoperative dysphagia occurred in 31 patients (32.6%) at the early postoperative time point. Multivariable logistic regression identified higher mFI-11 score (OR, 4.03; 95% CI: 1.24-13.16; P =0.021), overcorrection of TS-CL after surgery (TS-CL, T1 slope minus C2-C7 lordosis; OR, 0.86; 95% CI: 0.79-0.95; P =0.003), and surgery at C3/C4 (OR, 12.38; 95% CI: 1.41-108.92; P =0.023) as factors associated with postoperative dysphagia.
Frailty, as assessed by the mFI-11, was significantly associated with postoperative dysphagia after ACSS. Additional factors associated with postoperative dysphagia were overcorrection of TS-CL and surgery at C3/C4. These findings emphasize the importance of assessing frailty and cervical alignment in the decision-making process preceding ACSS.
回顾性分析前瞻性收集的登记资料。
本研究旨在探讨虚弱和影像学参数对颈椎前路手术后吞咽困难的影响。
越来越多的文献表明，虚弱与各种手术后的术后并发症增加有关。然而，很少有研究调查颈椎前路手术后与术后吞咽困难之间的关系。
纳入因退行性颈椎病变接受颈椎前路手术的患者。通过改良的虚弱指数-11 （mFI-11）和吞咽评估工具 10 （EAT-10）分别评估虚弱和吞咽困难。我们还收集了先前报道为术后吞咽困难危险因素的临床人口统计学和颈椎排列参数。采用多变量逻辑回归分析确定术后早期（2-6 周）和晚期（1-2 年）吞咽困难的优势比（OR）。
本研究纳入了 95 例接受颈椎前路手术的患者。术后早期吞咽困难发生在 31 例患者（32.6%）。多变量逻辑回归分析确定较高的 mFI-11 评分（OR，4.03；95%CI：1.24-13.16；P=0.021）、术后 T1 斜率- C2-C7 后凸（TS-CL）过度矫正（OR，0.86；95%CI：0.79-0.95；P=0.003）和 C3/C4 手术（OR，12.38；95%CI：1.41-108.92；P=0.023）与术后吞咽困难有关。
通过 mFI-11 评估的虚弱与颈椎前路手术后吞咽困难显著相关。与术后吞咽困难相关的其他因素是 TS-CL 的过度矫正和 C3/C4 手术。这些发现强调了在颈椎前路手术前的决策过程中评估虚弱和颈椎排列的重要性。
