Peospective Analysis of Incidence and Risk Factors of Dysphagia in Spine Surgery Patients
Comparison of Anterior Cervical, Posterior Cervical and Lumbar Procedures
Carol A. Smith-Hammond, PhD, CCC/SLP, Kent C. New, MD, PhD, Richardo Pietrobon, MD, David J. Curtis, MD, Candice H. Scharver, MA and Dennis A. Turner, MA, MD
A 3-year prospective, cohort study.
To compare the incidence and risk factors of dysphagia after anterior cervical (AC), posterior cervical (PC), and posterior lumbar (PL) spine procedures.
Eighteen (47%) AC, 4 (21%) PC, but no PL patients demonstrated dysphagia on postoperative videofluoroscopic swallow evaluation. Age (>60 years, P <0.01) was associated with increased risk of radiologic evidence of dysphagia. Over 70% (12 of 17) of AC patients with dysphagia followed recovered within 2 months, while 23% (4 of 17) required some level of compensatory swallowing behavior up to 10 months following surgery.
Dysphagia is a common occurrence after AC procedures but was also found after PC procedures. Intubation alone was not a risk factor for postoperative dysphagia in this cohort.
We report a prospective study on the incidence and risk factors of dysphagia in patients undergoing spine surgery, including anterior cervical (AC), posterior cervical (PC), and posterior lumbar (PL) spine procedures. The goal of this study was to determine the incidence of clinically significant dysphagia after these various procedures, risk factors associated with dysphagia, and the duration of the postoperative swallowing deficit.
I cough when I eat solid food.
I cough when I drink liquids.
I feel thirsty most of the time.
I’ve lost weight because of my swallowing problem.
I avoid some foods because of my swallowing problem.
It’s hard to chew food.
I’m embarrassed to eat in public.
I’m embarrassed because of drooling.
I’m tired at the end of a meal.
I eat smaller meals more often due to my swallowing problem.
I have to swallow again before food will go down.
I don’t enjoy eating as much as I used to.
I eat less because of my swallowing problem.
I am nervous because of my swallowing problem.
I feel handicapped because of my swallowing problem.
I get angry at myself because of my swallowing problem.
I’m afraid that I’ll choke and stop breathing because of my swallowing problem.
I’ve changed my diet due to my swallowing problem.
It takes me more than 45 minutes to eat a meal.
I feel a strangling sensation when I swallow.
My swallowing problem upsets me.
I have to thicken liquids in order to swallow them.
I choke when I take my medication.
I feel that liquid goes down the wrong way when I swallow.
Age was found to be a statistically significant risk factor, as patients with dysphagia were older than those without (59.2 ± 11.3 years, vs. 51.7 ± 9.2 years, P < 0.01).
Proposed mechanisms include esophageal edema secondary to retraction and stretch injury to nerves involved in the swallowing mechanism.
The reported incidence of dysphagia after anterior cervical decompression and fusion (ACDF) varies widely (11%-67%). Intubation, which alone has been reported to cause dysphagia in as many as 12% of patients.20
The incidence of dysphagia after ACDF was high, nearly 50%, the incidence after PC surgery was over 20%. To our knowledge, this is the first documentation of dysphagia after PC spine surgery.
Patient age was found to have a significant effect on the risk of dysphagia.
- Almost half of anterior and more than 20% of posterior cervical spinal surgery patients demonstrated risk for aspiration within the first few days of the procedure.
- Most patients with dysphagia recover within weeks to normal swallowing.
- Age greater than 60 years is a risk factor associated with postoperative dysphagia.
- Intubation alone was not a risk factor for postoperative dysphagia based on objective swallow evaluations.