JBJS - 2026-03-18 - Journal Article
Subjective and Functional Dysphagia After Anterior Cervical Spine Surgery: A Prospective Controlled Study.
Louie PK, Lipson P, Alostaz M, Bansal A, Cherel M, Reynolds L, Shen J, Eley N, Varley E, Leveque JC, Nemani VM
Topics
Key Takeaway
Dysphagia occurred in 70.1% of ACDF/CDR patients on POD0 and persisted in 35.8% at POD30, compared to 13.4% and 4.5% in lumbar controls, supporting its classification as a common self-limited symptom rather than a true complication.
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Summary
This prospective controlled study quantified dysphagia incidence and time course after anterior cervical surgery (up to 3-level ACDF/CDR) using EAT-10 scores and Yale Swallow Protocol, with lumbar decompression patients as controls. Dysphagia prevalence in the cervical group exceeded controls at every postoperative time point (70.1% vs 13.4% at POD0; 35.8% vs 4.5% at POD30; all p≤0.001). Retropharyngeal swelling resolved by first follow-up at most levels except C3-C4, and male sex was independently associated with lower EAT-10 scores through POD7.
Key Limitation
Follow-up ends at 30 days, so the natural history of the 35.8% of cervical patients still symptomatic at POD30—including time to full resolution and rate of persistent dysphagia—remains uncharacterized.
Original Abstract
BACKGROUND
Dysphagia is a common postoperative complaint following anterior cervical discectomy and fusion (ACDF), with incidence rates ranging from 1.7% to 71%. The variability in incidence rates raises the question of whether dysphagia warrants clinical concern or represents a transient, expected symptom. The aim of this study was to characterize the time course and impact of dysphagia following anterior cervical surgery for degenerative pathology with use of both subjective and objective measures.
METHODS
Patients undergoing either lumbar or cervical spine surgery from 2023 to 2024 were prospectively enrolled. Lumbar cases were limited to 1 to 2-level, decompression-only procedures, whereas cervical cases included up to 3-level ACDF and/or cervical disc replacement (CDR). Dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the Yale Swallow Protocol at 5 time points: preoperatively and on postoperative days (PODs) 0, 3, 7, and 30. Postoperative responses were collected electronically. Retropharyngeal radiographic measurements at C3-C7 were obtained preoperatively, immediately postoperatively, and at the first follow-up. Measurements were taken from the vertebral midbody to the posterior airway space.
RESULTS
A total of 134 patients (67 in the cervical group and 67 in the lumbar group) were included. The groups were demographically similar, although the cervical group had a longer mean operative time (86.7 versus 62.2 minutes; p < 0.001). Dysphagia was more prevalent in the cervical group across all postoperative time points: POD0 (70.1% versus 13.4%), POD3 (64.2% versus 10.4%), POD7 (40.3% versus 6.0%), and POD30 (35.8% versus 4.5%) (all p ≤ 0.001). EAT-10 scores correlated strongly across postoperative time points and modestly with procedure duration. Male sex was associated with lower EAT-10 scores through POD7 (p < 0.001). Intraoperative steroid use trended toward reduced EAT-10 scores but was not significant after correction. Retropharyngeal measurements increased immediately postoperatively (notably at C3, C4, C5, and C7), but swelling resolved by the time of follow-up, except at C3 and C4.
CONCLUSIONS
Dysphagia was frequent after anterior cervical surgery, peaking early and partially resolving by 1 month. These findings support its characterization as a common, self-limited postoperative symptom rather than a true complication in most cases.
LEVEL OF EVIDENCE
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.