Smoking can be a risk factor for dysphagia after anterior cervical spine surgery

ORLANDO, Fla., — Patients who are regular smokers have a higher rate of dysphagia after anterior cervical spine surgery, according to data presented here at the Cervical Spine Research Society Annual Meeting.

Perspective from Bawarjan Schatlo, MD

Erik C. Olsson, MD, presented results of a cross-sectional cohort study which analyzed 100 patients who underwent anterior cervical spine surgery and fusion between 2008 and 2012. The study included 51 men and 49 women, of which 21 patients were active smokers.

Erik C. Olsson

He said the overall prevalence of dysphagia in the study was 26% and at 33 months it was 23% among patients who underwent only primary surgery.

“Smokers had higher preoperative pain scores and were more likely to experience dysphagia. Their symptoms, when they experienced dysphagia, were more severe when compared to non-smokers or former smokers,” Olsson said.

Olsson and colleagues assessed dysphagia severity with the Bazaz-Yoo questionnaire. They measured pain with the VAS sore. Smoking status at the time of the index surgery was assessed prospectively, as well.

According to data in the study, the overall rate of dysphagia at 2.75 years was 26%. Smokers had more severe symptoms of dysphagia than non-smokers or former smokers. Smokers also had higher dysphagia scores than non-smokers; 1.17 points vs. 0.54 points; P = 0.02.

Olsson presented data that showed 71% of the seven patients who underwent revision surgery experienced symptoms of dysphagia.

He said current smokers should be counseled prior to undergoing anterior cervical spine surgery to warn them of the high risk of developing postoperative dysphagia.

“We identified smokers as an at-risk population that warrants follow-up prospective research on possible interventions to mitigate their risk of dysphagia,” Olsson said.

Several factors in the study were not associated with the severity or occurrence of dysphagia. Olsson noted that these were age, sex, diagnosis, preoperative pain severity and number of levels treated. – by Robert Linnehan

Reference:

Olsson EC, et al. Paper #32. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 4-6, 2014; Orlando, Fla.

For more information:

Erik C. Olsson, MD, can be reached at the University of North Carolina School of Medicine, 321 South Columbia St., Chapel Hill, NC 27516; email: erik_olsson@med.unc.edu.

Disclosure: Olsson reports no relevant financial disclosures.

Perspective

Bawarjan Schatlo, MD

Olsson, Jobson and Lim have analyzed a cohort 100 patients who underwent anterior cervical discectomy and fusion. Long-term follow-up revealed 23% of patients undergoing a first-ever anterior cervical discectomy and fusion (ACDF) had signs of dysphagia even at an average of almost 3 years. The authors identified smoking and previous surgery as risk factors for long-term dysphagia. Curiously, factors which were associated with dysphagia in other studies such as sex, number of levels and age, were not associated with dysphagia in their cohort.

Bawarjan Schatlo

This well-conducted study revealed smoking may be a potential variable to include in the decision-making process. Why a previous prospective cohort study in 43 patients by Kepler and colleagues found the proportion of smoking patients was similar in patients with and without dysphagia after ACDF cannot be answered at present. Smokers also have a well-known increased risk of non-fusion.

The next interesting question to answer is to which degree the combined risk of nonunion, dysphagia and cardiopulmonary complications of anesthesia is higher in smoking patients. Spine surgeons should directly discuss the high risk of dysphagia with their patients. This paper reminds us that the negative impact on smoking should be honestly but delicately addressed preoperatively. In my experience, an open discussion may lead to an increased self-awareness in our patients and – sometimes – provide them with the necessary stimulus to stop smoking.

Bawarjan Schatlo, MD

Consultant and Board-Certified Neurosurgeon University Hospital Göttingen

Göttingen, Germany

Disclosures: Schatlo reports no relevant financial disclosures.