Skip to main content
  • Risk Factors and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery in Patients With Degenerative Cervical Myelopathy: Results from the AOSpine International and North America Studies

    Final Number:

    Lindsay Tetreault Bsc; Narihito Nagoshi MD, PhD; Hiroaki Nakashima MD; Paul M. Arnold MD; Giuseppe Barbagallo MD; Branko Kopjar MD; Michael G. Fehlings MD PhD FRCS(C) FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The objective of this study is to determine the incidence and risk factors of postoperative dysphagia and to evaluate short- and long-term clinical outcomes in patients with this complication.

    Methods: Four hundred and seventy patients undergoing an anterior or a 2-stage surgery were enrolled in the prospective AOSpine CSM-North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of dysphagia. Preoperatively and at each follow-up, patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and the SF-36. A mixed model analytic approach was used to evaluate differences in outcomes at 6- and 24-months between patients with and without dysphagia, while controlling for relevant baseline characteristics and surgical factors.

    Results: The overall incidence of dysphagia was 6.17%. Univariately, the major risk factors for perioperative dysphagia were a higher co-morbidity score (OR:1.289,p=0.0019), the presence of cardiovascular (OR:2.584,p=0.0163) and endocrine (OR:4.234,p=0.0003) disorders, a 2-stage surgery (OR (ref=1-stage):6.506,p=0.0003) and a greater number of decompressed levels (OR:1.816,p=0.0022). Based on multivariate analysis, patients were at an increased risk of perioperative dysphagia if they had diabetes (OR (ref=absence):3.686,p=0.0014), a greater number of decompressed segments (OR: 1.522,p=0.0498), and a 2-stage surgery (OR (ref=1-stage):3.423,p=0.037). Clinical improvements, as evaluated by the Nurick and mJOA, were comparable between patients with and without dysphagia at both short- and long-term follow-up. In contrast, patients with dysphagia had significantly worse scores on the NDI at 6-months postoperative than patients without dysphagia; however, at 24-months postoperative, there were no difference between groups.

    Conclusions: The most important predictors of dysphagia are diabetes, a greater number of decompressed levels and a 2-stage surgery. Patients with postoperative dysphagia have reduced disability and quality of life improvements in the short-term but not in the long-term.

    Patient Care: By identifying high risk patients, clinicians can take appropriate preoperative and postoperative precautions to avoid dysphagia.

    Learning Objectives: To determine the risk factors of dysphagia and discuss whether this complication affect surgical outcomes.


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy