Review ArticleDysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures
Introduction
Anterior cervical spine surgery (ACSS) is a common procedure performed to treat many spine conditions, such as trauma and degenerative spinal disease. Many studies have reported that one of the most common complications after ACSS is dysphagia [1], [2], [3]. The reported incidence of dysphagia is widely variable and is likely due to the heterogeneity of the existing literature. However, an incidence of up to 71% has been reported in well-designed prospective studies that assess the dysphagia rate after surgery [4]. Several risk factors have been associated with an increase in postoperative dysphagia incidence, including multilevel surgery, revision procedures, female gender, older age, and involvement of C4–C5 and C5–C6 levels [5], [6]. The objective of this study was to review potential measures that could be used to decrease the incidence and intensity of postoperative dysphagia after ACSS.
Section snippets
Material and methods
A systematic review of the literature using the Medline database (National Library of Medicine), without time restriction, was performed. The following search strategy was used: (“deglutition disorders”[MeSH Terms] OR (“deglutition”[All Fields] AND “disorders”[All Fields]) OR “deglutition disorders”[All Fields] OR “dysphagia”[All Fields]) AND anterior[All Fields] AND (“neck”[MeSH Terms] OR “neck”[All Fields] OR “cervical”[All Fields]) AND (“surgery”[Subheading] OR “surgery”[All Fields] OR
Results
The 20 articles that met all inclusion and exclusion criteria are summarized in Table 1, and the preventative measures proposed are described in Table 2. The following articles are described in the following:
Discussion
Many risk factors are associated with postoperative dysphagia after ACSS. The incidence varies from 1.7% to as high as 71%, probably due to differences in study designs and definition/measurements of dysphagia after ACSS [4], [27]. Fortunately, most of the times, symptoms are mild and transitory, decreasing over the weeks, although 12% to 14% of the patients can present persistent dysphagia even after 1 year [27]. The most probable explanation for dysphagia after ACSS is that it is a
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2022, Seminars in Spine SurgeryCitation Excerpt :One prospective, non-randomized trial found no significant difference in the incidence of dysphagia between patients who received intravenous injection of methylprednisolone and those who did not.28 Some studies have reported a significant reduction in self-reported dysphagia scores following the use of local retropharyngeal steroids administered intraoperatively.17,28,29 A more recent study raises concern on the effect retropharyngeal steroids can have on ACDF fusion rates.22
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FDA device/drug status: Not applicable.
Author disclosures: AFJ: Nothing to disclose. JM: Nothing to disclose. JWS: Nothing to disclose. AAP: Royalties: Amedica (B, Paid directly to the employer), Ulrich; Private Investments: Amedica, Cytonics, Nocimed (Personal Investments <1%); Consulting: DePuy (B, Paid directly to the employer), Amedica (B, Paid directly to the employer), GE Healthcare (B, Paid directly to the employer), Stryker (B, Paid directly to the employer), Zimmer (B, Paid directly to the employer), Biomet.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The authors have no financial interest in the subject of this article. The manuscript submitted does not contain information about medical device(s).