Predictive Factors of Post-operative Dysphagia in Single-level Anterior Cervical Discectomy and Fusion (ACDF).

STUDY DESIGN: Retrospective review of prospectively collected data OBJECTIVE.: To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level ACDF.

SUMMARY OF BACKGROUND DATA: Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy.

METHODS: Dysphagia was assessed by SWAL-QOL scores pre operatively, at 6 weeks and 12 weeks. PROMs including VAS and NDI were collected pre operatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable.

RESULTS: 64 patients were included, 41 received a zero profile device, and 23 received plate/cage construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs 54.43 ± 14.71 minutes, p = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed pre-operative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs 3.43 ± 3.21, p = 0.007).

CONCLUSIONS: Operative time and pre-operative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.

LEVEL OF EVIDENCE: 3.