Elsevier

The Spine Journal

Volume 14, Issue 9, 1 September 2014, Pages 2246-2260
The Spine Journal

Review Article
Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures

https://doi.org/10.1016/j.spinee.2014.03.030Get rights and content

Abstract

Background context

Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender.

Purpose

The objective of this study was to review and define potential preventative measures that can decrease the incidence of dysphagia after anterior cervical spine surgery.

Study design

This was a systematic literature review.

Methods

A systematic review in the Medline database was performed. Articles related to dysphagia after anterior cervical spine surgery and potential preventative measures were included.

Results

Twenty articles met all inclusion and exclusion criteria. These articles reported several potential preventative measures to avoid postoperative dysphagia. Preoperative measures include performing tracheal exercises before the surgical procedure. Intraoperative measures can be summarized as avoiding a prolonged operative time and the use of recombinant human bone morphogenetic protein in routine anterior cervical spine surgery, using small and smoother cervical plates, using anchored spacers instead of plates, application of steroid before wound closure, performing arthroplasty instead of anterior cervical fusion for one-level disease, decreasing tracheal cuff pressure during medial retraction, using specific retractors, and changing the dissection plan.

Conclusions

Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia.

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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    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).

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