Perioperative Dysphagia Considerations for Patients With Severe Cervical Spondylotic Myelopathy.

Abstract

Study design: Cohort study with consecutive cases.

Objectives: Dysphagia after anterior cervical spine surgery is a well-known complication. The aim of this study is to identify risk factors for dysphagia in patients with cervical myelopathy requiring surgery.

Methods: We conducted a prospective analysis of 92 consecutive patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical spine surgery. All patients underwent a pre- and postoperative swallowing evaluation using the Eating Assessment Tool (EAT-10) and the Hyodo-Komagane (H‒K) score, an endoscopic scoring method used by an examining otolaryngologist to assess dysphagia.

Results: None of the patients had dysphagia when assessed using EAT-10; however, 15.2% of patients had H‒K scores indicative of dysphagia. Preoperative latent dysphagia was highly correlated with postoperative dysphagia (r = 0.51, P < 0.0001). No significant difference was found for the presence of dysphagia due to a history of smoking, dialysis, diabetes, asthma, and restrictive and/or obstructive ventilation disorder. The 10-s grip and release test (P < 0.0001) and the upper extremity function (P = 0.004) and bladder function (P = 0.0008) items from the Japanese Orthopaedic Association scores significantly correlated with H‒K scores.

Conclusion: This study suggests that advanced age and severe preoperative upper limb and bladder dysfunction are risk factors for dysphagia in patients with cervical myelopathy requiring surgery.