Background 

An impairment of swallowing (aka dysphagia) is a debilitating but commonly-reported consequence of Anterior Cervical Discectomy and Fusion (ACDF) surgery, a “gold standard” procedure that is performed to treat cervical spine disorders. Despite it’s common occurrence, significant gaps in understanding the pathophysiology of dysphagia after ACDF remain, as previous literature is limited by retrospective study designs and/or lacks instrumental imaging of swallowing. Further, conventional wisdom holds that inefficient swallowing is exacerbated by solid (vs liquid) food; yet, solid foods are rarely measured in swallowing research. Therefore, our objectives were to prospectively quantify within-subject changes to pharyngeal wall thickness (representing pharyngeal edema) and the material remaining in the pharynx post-swallow (representing pharyngeal residue) on solid foods captured using videofluoroscopy. Our goal was to determine whether residue and/or edema are driving perceptions of dysphagia using patient reported outcome (PRO) scales. 

 Methods 

Twenty-one patients undergoing ACDF surgery (17 males, mean age = 52.2) completed videofluoroscopy and the Patient Reported Outcome (PRO) scale, EAT-10, both pre- and 6-weeks postoperatively. Pixel-based measures of pharyngeal residue and edema were completed while blind to the timepoint. Pharyngeal residue and edema were correlated with total PRO scores (and with relevant individual PRO items) to explore whether these phenomena drive patient perception of swallowing impairment. 

Results

Both pharyngeal residue and edema measures significantly increased post-surgery.  There was a substantial correlation between residue and all PRO scores (increased residue reflecting worse perceived dysphagia). However, no significant relationships were revealed between edema and the PRO scores. (total or individual items) 

Conclusions

The analysis indicates that ACDF surgery poses a concern with swallowing efficiency, and patient perceived swallowing difficulties appear to be driven more by the presence of residue than edema. These findings highlight the importance of holistic assessments in ACDF patients, emphasizing the need for both instrumental evaluations and PROs to capture disruption to swallowing.

References

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2. Leonard, R., & Belafsky, P. (2011). Dysphagia following cervical spine surgery with anterior instrumentation: evidence from fluoroscopic swallow studies. Spine, 36(25), 2217-2223.

3. Jones-Rastelli, R.B., et al. (2023). Alterations in Swallowing Six Weeks After Primary Anterior Cervical Discectomy and Fusion (ACDF). Dysphagia.

4. Belafsky, Peter C., et al. (2008). Validity and reliability of the Eating Assessment Tool (EAT-10). Annals of Otology, Rhinology & Laryngology 117.12: 919-924.

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6. Hughes, AP., et al. (2018). HSS dysphagia and dysphonia inventory (HSS-DDI) following anterior cervical fusion: patient-derived, validated, condition-specific patient-reported outcome measure outperforms existing indices. JBJS 100.10: e66.

7. Steele et al (2020). Measurement of Pharyngeal Residue From Lateral View Videofluoroscopic Images. JSLHR, 63(5), 1404–1415.

8. Turcotte et al (2018). Analysis of pharyngeal edema post‐chemoradiation for head and neck cancer: Impact on swallow function. Laryngoscope Investigative Otolaryngology, 3(5), 377–383. 

Acknowledgements/Disclosures

This research was funded in part by the NYU CTSI Pilot Project Funding (PI Molfenter) NIH/NCATS UL1TR001445. We acknowledge NYU Langone Health collaborators from the Departments of Neurosurgery and Orthopedic Surgery and the NYU Voice Center for their support of this research.

Researchers Biographies