Anterior cervical discectomy and fusion (ACDF) requires an anterior transcervical approach (ACA) to allow decompression of the cervical spine and nerve roots. This approach is also occasionally used for corpectomy and osteophyte removal. Key neurovascular structures related to swallowing and voice need to be navigated during this surgery, therefore dysphagia and dysphonia can both occur postoperatively. The exact incidence of and persistence of these symptoms varies across the literature. This study aimed to assess the frequency and severity of long-term dysphagia and dysphonia as well as the incidence requiring ongoing otolaryngological care. Retrospective data (demographics, surgical approach, otolaryngological clinical details) from 454 patients who underwent ACA was collected. Patients were asked to complete the Eating Assessment Tool (EAT-10) and Voice Symptoms Scale (VoiSS) to assess presence of swallowing or voice difficulties in all patients, regardless of ongoing otolaryngology input. Of the whole cohort, 48 patients (10.6%) had required otolaryngology follow-up for swallowing issues, and 31 patient (6.8%) for voice issues. Of the 140 patients who completed questionnaires at three months post-ACA, EAT-10 scores were abnormal for 57 (40.7%) and VoiSS scores for 78 (55.7%). At 12 months, of the 110 patients who participated, EAT-10 scores were abnormal for 46 (41.8%) and VoiSS 60 (54.5%). Low cervical (below C6) ACA approaches were independently associated with an increased risk of dysphagia and dysphonia more than 12 months post-surgery. This study recommends that whilst ACA approaches are necessary for accessing the cervical spine, persistent swallowing and voice difficulties are underreported and need to be explored with patients as part of their care before, during and after surgery.
How are swallowing and voice affected following anterior cervical discectomy and fusion (ACDF)?
Reviewed by Gemma Clunie
Characterizing Long-Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach.
CONTRIBUTOR
Gemma Clunie
BA (Hon), MSc, PhD, MRCSLT, Imperial College Healthcare NHS Trust; Honorary Research Fellow, Imperial College London, UK.
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