Dysphagia Prevention in Anterior Cervical Discectomy Surgery: Results from a Prospective Clinical Study

Background: Dysphagia is a common complication after anterior cervical discectomy surgery (ACDS). Recent studies have shown that reducing the endotracheal tube cuff pressure, local irrigation with methylprednisolone, and minimizing the pharynx/esophagus retraction can decrease the incidence of postoperative dysphagia after ACDS. This is the first study assessing the efficacy of all these 3 measures simultaneously. Methods: This prospective study included 35 patients (group 1) who underwent ACDS with the adoption of all the 3 preventive measures. Group 1 was compared with a homogenous group of 35 patients who underwent regular ACDS (group 2). Postoperative dysphagia and odynophagia were evaluated after 2, 7, and 14 days and 3, 6, and 12 months. Age, gender, body mass index (BMI), operating time, blood loss, and preoperative Japanese Orthopaedic Association score were collected. Results: Postoperative dysphagia was observed in 3 cases (8.6%) in group 1 and 15 cases (42.9%) in group 2 (P < 0.05). Three patients in group 1 had transient dysphagia with complete resolution at the last follow-up whereas 6 patients in group 2 (17.1%) had permanent dysphagia (P < 0.05). Nine patients (25.7%) in group 2 presented with transient dysphagia with complete resolution at the last follow-up. The mean visual analog scale for odynophagia was significantly lower in group 1 compared with group 2 (P < 0.05). Conclusions: Postoperative dysphagia occurs frequently after ACDS. We show that the adoption of preventive measures during surgery can reduce the rate of dysphagia. Future evaluations in a large clinical trial are mandatory. © 2019 Elsevier Inc.