A Comparison of Dysphagia Rates of Long Segment Anterior vs Posterior Cervical Fusion

Introduction: Dysphagia is a common adverse outcome following anterior cervical discectomy and fusion (ACDF). However, current literature lacks comparisons of long-term dysphagia rates between ACDF and posterior cervical fusion. The objective of this study is to compare rates of dysphagia following long-segment (≥ 3 levels) ACDF and posterior cervical fusion ≥ 3 levels at 3-months and 12-months postoperatively.

Methods: A prospectively collected quality improvement database was utilized to identify patients who had a long-segment cervical spinal fusion. Cohorts were divided into ACDF and posterior cervical fusion groups. EAT10 scores were obtained for all patients preoperatively and at 3- and 12-months postoperatively.

Results: A total of 132 patients met the inclusion criteria, 72 of whom had undergone ACDF and 55 of whom had undergone posterior cervical fusion. There were similar follow-up rates for each cohort at 3-months (92.2% vs 87.3%, p = 0.35) and at 12-months (68.8% vs 74.5%, p = 0.47). Dysphagia rates at baseline were similar for the two cohorts (13.0% vs 18.2%, p = 0.41). At 3-month follow up, 42.3% of the ACDF group and 35.4% of the posterior group had dysphagia (p = 0.45). EAT10 scores (ACDF 4.56 ± 7.22 vs Posterior 4.38 ± 7.58, p = 0.89) and change in EAT10 scores from baseline (ACDF 2.75 ± 8.86 vs Posterior 1.33 ± 5.61, p = 0.33) were similar at 3-month follow up. At 12-month follow up, 32.6% of the ACDF group and 32.4% of the posterior group had dysphagia (p = 0.98). The 12-month follow-up data also showed similar EAT10 scores (ACDF 4.92 ± 6.84 vs Posterior 4.49 ± 6.63, p = 0.76) and change in EAT10 scores from baseline (ACDF 2.55 ± 7.99 vs Posterior 1.63 ± 5.49, p = 0.53).

Conclusion : For long-segment cervical fusions, there are similar rates of dysphagia for ACDF and posterior cervical fusions at 3-months and at 12-months postoperatively. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than surgical approach.