Dysphagia Following Anterior Cervical Spine Surgery: Assessment Using an Abridged SWAL-QOL

Background Study design: Retrospective cohort study. Objective: To determine which components of the swallowing disorders quality of life (SWAL-QOL) survey are most relevant to assess dysphagia following anterior cervical spine surgery (ACSS). Summary of background data: The SWAL-QOL survey is an instrument that has been applied to patients undergoing ACSS procedures as a means of objectifying swallow function. However, the SWAL-QOL is lengthy, cumbersome, and primarily used for otolaryngological procedures.

Methods Patients undergoing ACSS procedures were administered the SWAL-QOL prior to surgery and at 6- and 12-week postoperative visits. The preoperative and postoperative SWAL-QOL scores were compared using paired t tests. Questions with statistically and clinically significant postoperative changes were used to create an abridged survey.

Results Fifty patients completed surveys at all 3 encounters and were included in the analysis. The total scaled score at 6 weeks was significantly lower than the preoperative score (P = .003) but returned to near baseline scores by 12 weeks (P = .178). Five sections had significantly lower scores at both postoperative visits compared to their respective preoperative values. Additionally, 13 individual questions had significantly lower scores at both postoperative visits, while 8 had significantly lower scores at only 1 of the postoperative visits. Of these 21 questions demonstrating statistical significance, 16 also demonstrated a clinically significant decrease (>5.0%) from preoperative scores. These 16 questions were included in the abridged survey developed for use in ACSS patients.

Conclusions The results of this study suggest that several questions in the full SWAL-QOL questionnaire demonstrated minor or no changes at postoperative visits following ACSS. As a result, we propose a modified, 16-question SWAL-QOL survey including only questions that were both statistically and clinically significant. This truncated survey may be better suited for use in cervical spine patients.