Original ArticleComparison of Chronic Dysphagia in Standalone versus Conventional Plate and Cage Fusion
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
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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.