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Postoperative Dysphagia as a complication of Anterior Cervical Spine Surgery

Author: 
Surendra K Chaudhary, Yu Bin, Pan Fumin, Wang Shanjin and Wu Desheng
Subject Area: 
Health Sciences
Abstract: 

Background: Postoperative dysphagia is a common occurrence for the patients undergoing anterior cervical spine surgery. Although multiple risk factors for developing dysphagia have been reported in the literature, but the controversy still exists among different studies. This study mainly focuses on the recent literature review and summarizes the general overview on the incidence, risk factors, pathophysiology, clinical signs and symptoms, assessment, treatment, and prevention of postoperative dysphagia. Methods: A computerized review of literature concerning with the dysphagia after anterior cervical spine surgery was searched on Pubmed. The literature search was confined to the published articles from 2005 to 2016. Results: Patients presenting with postoperative dysphagia after anterior cervical surgery have a range of clinical symptoms from the difficulty initiating a swallow, chewing problem to nasal regurgitation, choking, coughing etc. Patient medical history, detailed physical examination, lateral X-ray radiographs, laryngoscopy and video fluoroscopic swallow evaluation (VSE) are the primary assessment tools for examining dysphagia. Universally validated objective method for measuring dysphagia is still lacking. The most commonly applied assessment tool is the Bazaz Dysphagia Scoring system. Dysphagia is purely the subjective sensation of discomfort, patient self-reported symptoms are more reliable and effective in recognizing swallowing disorders. The etiology of postoperative dysphagia after anterior cervical spine surgery remain multifactorial which include surrounding mucosal structures, muscular and, neuronal components. Most of the dysphagic problems are usually transient, which begins within one week of postoperative period but in some cases may last longer after surgery. The reported incidence of dysphagia has been observed upto 80% within one week following ACSS among different studies. The big variation in incidence rate can be related to different surgical techniques, duration of surgery, size and material of the implant used, variations in different measurement tools and definition of dysphagia, follow-up time intervals, and comparatively small sample studies. The most common contributing factors causing postoperative dysphagia are multilevel procedures, female gender, longer operative time, and advanced age (>60 years), use of rhBMP-2. Rehabilitation including dietary modification and training in swallowing techniques and maneuvers are the treatment strategies for the dysphagia by maintaining the patients’ adequate nutritional intake and maximizing airway protection. Certain preoperative maneuver likes tracheal traction exercise, intraoperative (use of steroids) and postoperative techniques could help in decreasing the incidence of postoperative dysphagia after anterior cervical spine surgery. Conclusions: Well designed, multicenter prospective studies of large sample size are necessary to conclude the incidence, exact etiology, risk factors, pathomechanisms and long-term follow-up for the development of postoperative dysphagia after ACSS, and also to discover preventative measures. Also the specific measurement; that is universally valid and reliable, is needed, which would include global, functional, physical, and psychosocial parameters to provide comparisons among different variables. The results of these large prospective studies can be employed to upgrade in surgical techniques and perioperative management, which may decrease the incidence of dysphagia after ACSS.

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