TITLE:
Incidence and Predictors of Dysphagia Following Anterior Cervical Discectomy and Fusion: Prospective Observational Study
AUTHORS:
Yingda Li, Kerry Hitos, Su-Thet Mon, Natalie Knight, Nick Vrodos
KEYWORDS:
Dysphagia, ACDF, Incidence, Predictors
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.1,
January
30,
2018
ABSTRACT: The incidence of dysphagia following anterior
cervical discectomy and fusion (ACDF) reported in the literature varies due to
differences in measures and time intervals applied, ranging from nearly 3/4 at
2 weeks to 13% at 12 months. The most commonly used dysphagia scales remain subjective,
non-validated, and do not capture functional impact. Various risk factors have
been identified, though few consistently reproduced and none studied in an
Australasian context. The aims of this study were to use objective and
validated measures, assess both traditional and novel risk factors, and
determine the impact of dysphagia on dietary status, length of stay and
complications. METHODS: Twenty-nine adults undergoing ACDF for degenerative
pathologies were enrolled between March and November 2015 in an Australian
institution. Bazaz dysphagia scale, Dysphagia short questionnaire, 3-ounce
swallow test and dietary status were assessed preoperatively, and 2 days and 6
weeks postoperatively. Descriptive statistics were used to characterise the
study sample and logistic regression modelling performed on risk factors.
RESULTS: Dysphagia incidence ranged from 85% on day-2 Dysphagia short questionnaire
to zero on 6-week 3-ounce swallow. All measures increased at 2 days and fell by
6 weeks. Failing day-2 3-ounce swallow was the only measure associated with
modifications in solids (P = 0.06), showing significant linear correlation (P =
0.02). Respiratory comorbidity increased risk of failing day-2 3-ounce swallow
by more than 32-fold (OR: 32.4; 95% CI: 1.8 - 587.7; P = 0.019) and scoring
moderate or severe on Bazaz by almost 10-times (OR: 9.3; 95% CI: 0.9 - 95.95; P
= 0.061). Psychiatric history also increased risk of failing day-2 3-ounce
swallow by more than 10-fold (OR: 10.9; 95% CI: 1 - 123.7; P = 0.054). Failing
3-ounce swallow increased length of stay (5 versus 7 days; P = 0.013).
CONCLUSIONS: Incidence of dysphagia following ACDF was dependent on the measure
used, though all improved over time. The 3-ounce swallow test correlated with
dietary modification and length of stay, while respiratory comorbidity posed
the most significant risk. This may identify a group of patients who may
benefit from early intervention.