Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA.
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Spine (Phila Pa 1976). 2024 Jul 1;49(13):909-915. doi: 10.1097/BRS.0000000000004965. Epub 2024 Feb 19.
Prospective multicenter cohort study.
To explore the association between operative level and postoperative dysphagia after anterior cervical discectomy and fusion (ACDF).
Dysphagia is common after ACDF and has several risk factors, including soft tissue edema. The degree of prevertebral soft tissue edema varies based on the operative cervical level. However, the operative level has not been evaluated as a source of postoperative dysphagia.
Adult patients undergoing elective ACDF were prospectively enrolled at 3 academic centers. Dysphagia was assessed using the Bazaz Questionnaire, Dysphagia Short Questionnaire, and Eating Assessment Tool-10 (EAT-10) preoperatively and at 2, 6, 12, and 24 weeks postoperatively. Patients were grouped based on the inclusion of specific surgical levels in the fusion construct. Multivariable regression analyses were performed to evaluate the independent effects of the number of surgical levels and the inclusion of each particular level on dysphagia symptoms.
A total of 130 patients were included. Overall, 24 (18.5%) patients had persistent postoperative dysphagia at 24 weeks and these patients were older, female, and less likely to drink alcohol. There was no difference in operative duration or dexamethasone administration. Patients with persistent dysphagia were significantly more likely to have C4-C5 included in the fusion construct (62.5% vs . 34.9%, P = 0.024) but there were no differences based on the inclusion of other levels. On multivariable regression, the inclusion of C3-C4 or C6-C7 was associated with more severe EAT-10 (β: 9.56, P = 0.016 and β: 8.15, P = 0.040) and Dysphagia Short Questionnaire (β: 4.44, P = 0.023 and (β: 4.27, P = 0.030) at 6 weeks. At 12 weeks, C3-C4 fusion was also independently associated with more severe dysphagia (EAT-10 β: 4.74, P = 0.024).
The location of prevertebral soft tissue swelling may impact the duration and severity of patient-reported dysphagia outcomes at up to 24 weeks postoperatively. In particular, the inclusion of C3-C4 and C4-C5 into the fusion may be associated with dysphagia severity.
前瞻性多中心队列研究。
探讨颈椎前路椎间盘切除融合术（ACDF）后手术节段与术后吞咽困难的关系。
吞咽困难是 ACDF 后的常见并发症，有几个风险因素，包括软组织水肿。术前椎体前方软组织水肿的程度取决于手术颈椎节段。然而，手术节段尚未被评估为术后吞咽困难的来源。
3 家学术中心前瞻性纳入择期行 ACDF 的成年患者。术前及术后 2、6、12 和 24 周采用 Bazaz 问卷、吞咽困难简短问卷和饮食评估工具-10（EAT-10）评估吞咽困难。根据融合构建中包含的特定手术节段对患者进行分组。多变量回归分析评估手术节段数量和每个特定节段纳入对吞咽困难症状的独立影响。
共纳入 130 例患者。总体而言，24 例（18.5%）患者在 24 周时仍有持续性术后吞咽困难，这些患者年龄较大、女性，且饮酒可能性较小。手术时间或地塞米松使用无差异。持续性吞咽困难患者 C4-C5 融合的可能性明显更高（62.5%比 34.9%，P=0.024），但其他节段无差异。多变量回归分析显示，C3-C4 或 C6-C7 的纳入与 EAT-10（β：9.56，P=0.016 和 β：8.15，P=0.040）和吞咽困难简短问卷（β：4.44，P=0.023 和 β：4.27，P=0.030）在 6 周时的严重程度更严重相关。12 周时，C3-C4 融合也与更严重的吞咽困难独立相关（EAT-10β：4.74，P=0.024）。
术前椎体前方软组织肿胀的位置可能会影响术后长达 24 周患者报告的吞咽困难结果的持续时间和严重程度。特别是 C3-C4 和 C4-C5 融合可能与吞咽困难严重程度相关。
