Dysphagia and its Natural History After Anterior Cervical Spine Surgery
Objective: To find out frequency of dysphagia after anterior cervical spine surgery using Bazaz dysphagia scoring.
Methods: Total of 70 patients who underwent anterior cervical spine surgery for different indications between June 2013 to June 2015 were included in the study. Age, gender, indication, level of involved vertebra, approach and type of surgery were recorded. Patients were assessed for dysphagia symptoms at 6 weeks, 3 months, and 6 months postoperatively using Bazaz dysphagia scoring.
Results: Total number of patients was 70 (n=70). Mean age of the patients was 39(±13.8), with minimum18 and maximum 65. 21(30%) were female and 49 (70%) were male. The most frequent indication for surgery was fracture with total of 42 (60%) while other indications included PID 19(27.1%), vertebral lesion/collapse 6 (8.6%), stenosis 2 (2.9%), chronic subluxation 1(1.4%). The most frequent level was C5, C6 with 22 (31.4%) cases. 7 cases (10%) had 2 level surgery while 63 (90 %) had one level surgery. In 50 (71.4%) cases ACDF (anterior cervical discectomy and fusion) was done, while ACCF (anterior cervical corpectomy and fusion) was done in 19(27.1%) and screw fixation was done in one case of odontoid fracture. Patients were assessed for dysphagia using Bazaz dysphagia scoring after 6 weeks, 3 months and 6 months. 3 (4.3%) patients were lost at follow up. Incidence of dysphagia at 6 weeks was 61.4% (43), at 3 months was 11.4 % (8) and at 6 months was 5.7 %(4). There was no significant difference between corpectomy and ACDF regarding incidence of dysphagia. Also, sidedness of incision, level of surgery, age and sex of the patients did not affect the results. However, there was marked difference in the incidence of dysphagia between two level surgery, 2 out of 7 (28.6%) and one level surgery, 2 out of 58(3.3%) at 6 months.
Conclusion: Although postoperative dysphagia is very common after anterior cervical spine surgery, it is a fairly benign condition and its frequency and severity decreases dramatically overtime.