Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e382-e388
World Neurosurgery

Original Article
Comparison of Chronic Dysphagia in Standalone versus Conventional Plate and Cage Fusion

https://doi.org/10.1016/j.wneu.2017.09.188Get rights and content

Introduction

Standalone cages have gained popularity because of their ease of implantation, reduced operating time, and lower profile compared with traditional plate and cage systems. The aim of this study was to compare the risk of chronic dysphagia between those who undergwent anterior cervical discectomy and fusion (ACDF) with traditional plating techniques and those who underwent standalone procedures.

Material and Methods

Between 2014 and 2015, we identified 377 consecutive patients who met the study criteria (standalone, n = 211; plate-cage, n = 166). Patient-specific characteristics and surgical characteristics were collected preoperatively. In addition, the Dysphagia Disability Index (DDI) was collected 2 years postoperatively by telephone interview.

Results

Among the patients who underwent a standalone procedure, 84% (n = 177) were available for their 2-year follow-up visit in comparison with 75% (n = 124) for plate-cage procedures. There was no statistically significant difference in postoperative DDI scores between the 2 groups, controlling for prior surgery and smoking. However, the strongest risk factors for higher DDI scores were prior cervical surgery (mean 6.0 points higher) and smoking (mean 6.2 points higher). Twenty-seven patients (8.9%) experienced chronic dysphagia. The risk was higher in the plate-cage group (n = 15, 12.1%) than in the standalone group (n = 12, 6.7%), but this difference did not reach statistical significance.

Conclusion

Despite similar mean DDI scores, patients who undergo anterior cervical discectomy with a plate-cage may be at a higher risk for chronic dysphagia than are those with a standalone approach, but further studies with larger sample sizes are necessary to establish this relationship with greater confidence.

Introduction

Anterior cervical discectomy and fusion (ACDF) is a well-established surgical technique used in the treatment of various disorders of the cervical spine.1 The conventional techniques of Cloward2 and Smith and Robinson3 use an interbody construct (structural allograft/autograft or cage [with or without graft in cage]) with an anterior cervical plate and screws for stabilization. In comparison, newer standalone anchored cages (with or without graft in cage) may avoid some of the complications seen when the conventional method is used, specifically dysphagia.4 Dysphagia can range from mild discomfort to the inability to properly control the muscles used for swallowing. Persistent dysphagia can result in serious medical complications and can potentially result in significant morbidity and possibly mortality. Although the exact cause of postoperative dysphagia is unknown, it has been speculated that both the profile of the plate in addition to adhesions and scar tissue have an impact on the esophagus, resulting in dysphagia.

The goal of this retrospective cohort study was to identify the differences in chronic dysphagia between the traditional plating techniques versus the standalone system to determine whether either leads to a greater risk of chronic postoperative dysphagia.

Section snippets

Study Design

This was a retrospective cohort study of adult patients treated at a single tertiary-care institution between January 2014 and December 2015. This study was an extension of a prior study on the same population that evaluated complications and pain outcomes. The study was approved by the Swedish Medical Center Institutional Review Board.

Study Population

Consecutive patients during the study period were identified, and those meeting the study criteria were included. Inclusion criteria were age 18 to 100 years,

Patient Demographics

Of the 384 patients identified as having undergone ACDF, 7 were excluded for procedures that did not meet the study criteria. Of the remaining patients (n = 377), 211 patients had undergone standalone cage procedures and 166 patients had undergone a plate-cage procedure.

Among the 211 patients who underwent a standalone procedure, 177 (84%) were available for their 2-year follow-up visit at a mean of 714 ± 123 days. Among the 166 who underwent a plate-cage procedure, 124 (75%) were available for

Discussion

The overall risk of dysphagia in this study was 8.9%, an alarmingly common complication. Despite average DDI scores not being significantly different between the standalone cage group and the plate-cage group, when the cutoff of 30 points or higher was used as the definition of dysphagia, the plate-cage group was at nearly twice the risk; however, this difference did not reach statistical significance. The literature reports a correlation between the risk of dysphagia and the number of operated

Conclusion

Chronic dysphagia is alarmingly common after ACDF, affecting nearly 9% of our patient population. Despite similar mean DDI scores, patients who undergo anterior cervical discectomy with a plate and cage may be at a higher risk of chronic dysphagia than are those with a standalone approach, but further studies with larger sample sizes are necessary to establish this relationship with greater confidence. Further studies are also needed to elucidate additional risk factors predisposing patients to

References (37)

  • G.W. Smith et al.

    The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion

    J Bone Joint Surg Am

    (1958)
  • P. Singh et al.

    Comparative analysis of interbody cages versus tricortical graft with anterior plate fixation for anterior cervical discectomy and fusion in degenerative cervical disc disease

    J Clin Diagn Res

    (2016)
  • A.K.J.B. Silbergleit et al.

    Dysphagia Disability Index: Development, Design and Validation

    (1997)
  • A.K. Silbergleit et al.

    The Dysphagia handicap index: development and validation

    Dysphagia

    (2012)
  • S.K. Cho et al.

    Dysphagia following anterior cervical spinal surgery: a systematic review

    Bone Joint J

    (2013)
  • L.H. Riley et al.

    Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study

    Spine (Phila Pa 1976)

    (2005)
  • E.C. Olsson et al.

    Risk factors for persistent dysphagia after anterior cervical spine surgery

    Orthopedics

    (2015)
  • M. Alimi et al.

    Anterior cervical discectomy and fusion (ACDF): comparison between zero profile implants and anterior cervical plate and spacer

    Cureus

    (2016)
  • Cited by (0)

    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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