Patients undergoing anterior cervical surgery at higher risk for dysphagia

SAN FRANCISCO — A controlled, prospective investigation that compared patients undergoing anterior cervical decompression and posterior lumbar decompression has found a higher incidence of postoperative dysphagia in the patients who had anterior cervical decompression.

“Given the results of the comparison of the cervical and lumbar patients, we concluded that the dysphagia that we found postoperatively was related to the anterior cervical surgery itself rather than potential confounding factors, including endotracheal tubes and general anesthesia,” Jeffrey A. Rihn, MD, said.

Rihn’s comments came during his presentation to the 24^th Annual Meeting of the North American Spine Society, here.

Patients were enrolled into two study groups: those undergoing an anterior one- or two-level cervical decompression and those undergoing lumbar decompression.

All patients filled out a dysphagia questionnaire preoperatively and then again at 2, 6 and 12 weeks postoperatively, Rihn of the Rothman Clinic at Jefferson Hospital in Philadelphia, said. This included a swallowing difficulty grading scale from zero to 10 and a questionnaire about swallowing difficulties with liquids and solids.

Data about operative time and number of levels involved were also recorded.

There were no significant differences in age body mass index (BMI) or preoperative incidence of dysphagia between the two groups.

There were 38 cervical cases and 56 lumbar cases in the study with a significant difference between the numbers of men in the groups — 29% of the cervical group and 63% in the lumbar group — and between operative times with the cervical cases taking 20 minutes longer on average.

“Postoperatively, 70% of the patients in the cervical group reported dysphagia and this decreased to 26% at 6 weeks and 8% at 12 weeks,” Rihn said. “This was statistically significantly greater than the lumbar group at 2 and 6 weeks and trended toward that at 12 weeks.”

The severity of the dysphagia was also worse in the cervical group; 40% at 2 weeks had moderate problems and 21% had severe problems compared to 9% and 2% respectively, according to the study’s abstract.

BMI and gender were not significantly related to the incidence of dysphagia at any of the time periods. Patients with two-level cervical surgery had increased postoperative dysphagia than those with one-level surgery.

Differences between the groups at baseline may have contributed to the study results, including gender, operative time, he said.

“The results of this study may not be applicable to patients having greater than two levels of surgery or patients undergoing revision cervical surgery.”

Reference:
Rihn JA, Kane J, Joshi A, et al. Dysphagia following anterior cervical surgery: A controlled prospective analysis. Paper #3. Presented at the 24th Annual Meeting of the North American Spine Society. Nov. 10-14, 2009. San Francisco.