• Christopher K Kepler, Jeffrey A Rihn, Jonathan D Bennett, David G Anderson, Alexander R Vaccaro, Todd J Albert, and Alan S Hilibrand.
• Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
• Spine J. 2012 Aug 1; 12 (8): 639-44.

Background ContextDysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia.PurposeTo determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia.Study DesignProspective cohort study.Patient SampleForty-three patients.Outcome MeasuresValidated dysphagia questionnaire, lateral cervical spine radiographs.MethodsPatients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling.ResultsForty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling at any time point.ConclusionsThere is a significant increase in anterior cervical soft-tissue swelling after ACDF. The width of prevertebral soft-tissue does not correlate with postoperative dysphagia.Copyright © 2012 Elsevier Inc. All rights reserved.

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