Related Factors For Dysphagia After Single-level Anterior Cervical Discectomy And Fusion

Objective: To explore the related factors of dysphagia after single-level anterior cervical discectomy and fusion.Methods: We retrospectively analyzed patients with cervical degenerative disc disease receiving single-level anterior cervical discectomy and fusion(AC DF)in First Affiliated Hospital of Soochow University from January 2011 to January 2015.During hospitalization,basic patient data and surgery-related data were recorded,including operation time,intraoperative blood loss,infusion volume,surgical segment,internal fixation device and the use of recombinant human bone morphogenetic protein-2(rh BMP-2).The cervical alignment(C A)and prevertebral soft tissue swelling(PSTS)were measured preoperatively and 3 days postoperatively.At 1,3,6,12,and 24 months postoperatively,the Bazaz swallowing function scoring system was used to assess the swallowing of the patients.We used the potential related factors of sex,age,smoking history,clinical manifestation,course length,body mass index(BMI),operation time,blood loss,infusion volume,surgical segment,internal fixation device,rh BMP-2,revision surgery,and postoperative C A and PSTS changes as independent variables.The occurrence of dysphagia after operation as a dependent variable.First,we usd chi-square test or Fisher exact test for univariate analysis,and then finished multi-factor analysis by Logistic regression model.Results: A total of 262 patients undergoing single-level ACDF were involved.The incidence of dysphagia at 1,3,6,12,and 24 months postoperatively was 35.9%,22.9%,15.6%,11.5% and 9.2%,respectively.The incidence of dysphagia was decreased over time,and the most significant reduction was in the first 6 months after surgery.Univariate analysis showed that the rate of dysphagia in operation time ? 3 hours was significantly higher than that of < 3 hours at 1 month postoperatively(P < 0.01);the rate of dysphagia in woman was significantly higher than that of man at 1 and 3 months postoperatively(P < 0.05);In addition,the incidence of dysphagia was significantly higher in course length ? 8 months was than that of < 8 months at 12 and 24 months postoperatively(P < 0.05).In the analysis of other independent variables,we found age,BMI,smoking,clinical manifestation,intraoperative blood loss,infusion volume,surgical segment,internal fixation device,rh BMP-2,revision surgery,and postoperative CA and PSTT changes have no significant difference on the occurrence of dysphagia after surgery.Logistic multivariate regression analysis showed that the duration of operation(? 3 hours),female and course length(? 8 months)were risk factors for dysphagia after single-level ACDF.Conclusion: Operation time and female may be associated with early and middle dysphagia postoperatively,and the course length may be associated with chronic dysphagia.Prevertebral soft tissue swelling and other factors are not related to dyspha gia after single-level AC DF.Risk factors for dysphagia after multi-level fusion should be further studied.