Comparison of Patient-Reported Postoperative Dysphagia in Patients Undergoing One-Level Versus Two-Level Anterior Cervical Discectomy and Fusion with the Zero-P Implant System

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

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Anterior Cervical Discectomy and Fusion With the Zero-profile Implant System for Cervical Spondylotic Myelopathy

Techniques in Orthopaedics ◽

10.1097/bto.0b013e3182908ff0 ◽

2014 ◽

Vol 29 (1) ◽

pp. 49-53 ◽

Cited By ~ 4

Author(s):

Denglu Yan ◽

Jian LI ◽

Zaihen Zhang

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Implant System

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Risk Factors for Dysphagia After Anterior Cervical Discectomy and Fusion With the Zero-P Implant System: a Retrospective Study With Minimum of 2 Years Follow-up

10.21203/rs.3.rs-138933/v1 ◽

2021 ◽

Author(s):

Rong Xue ◽

Ningdao Li ◽

Zhurong Ji ◽

Xingdong Cheng ◽

Zhuqiu Zhang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Operation Time ◽

Anterior Cervical Discectomy ◽

Postoperative Dysphagia ◽

Chi Square ◽

Chi Square Test ◽

Implant System ◽

Segmental Angle

Abstract Background: Dysphagia is one of the most common complications after anterior cervical spine surgery. The study aimed to evaluate the risk factors for dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. Methods: A retrospective analysis of 260 patients who underwent ACDF with the Zero-P Implant System and had at least 2 year of follow-up ware performed. All patients were divided into a non-dysphagia group and a dysphagia group. Sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue thickness, the levels of surgery, O-C2 angle, C2–7 angle, T1 slope and segmental angle were analyzed. Chi-square test and logistic regression were performed to analyze the predictive value of each dimension for dysphagia. Results: In total, the non-dysphagia group comprised 170 patients and the dysphagia group comprised 90 patients. Chi-square test results indicated that number of operated levels, operation time dT1 slope, dO-C2 angle, dC2–7 angle, segmental angle and dPSTT were associated with a high incidence of dysphagia. Multivariate logistic regression analysis showed that number of operated levels, operation time, dC2–7 angle and dPSTT were significantly associated with postoperative dysphagia.Conclusions: Number of operated levels, operation time, dC2–7 angle and dPSTT were significantly associated with postoperative dysphagia. In additionally, sufficient preoperative preparation, evaluation combining with proficient and precise treatment measures are suggested to reduce the incidence of postoperative dysphagia when ACDF is performed.

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Retropharyngeal cerebrospinal fluid collection as a cause of postoperative dysphagia after anterior cervical discectomy

Surgical Neurology ◽

10.1016/j.surneu.2006.07.019 ◽

2007 ◽

Vol 67 (5) ◽

pp. 499-503 ◽

Cited By ~ 12

Author(s):

Pietro Spennato ◽

Armando Rapanà ◽

Ettore Sannino ◽

Corrado Iaccarino ◽

Enrico Tedeschi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Fluid Collection ◽

Anterior Cervical Discectomy ◽

Postoperative Dysphagia ◽

Cervical Discectomy

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Impact of local steroid application on dysphagia following an anterior cervical discectomy and fusion: results of a prospective, randomized single-blind trial

Journal of Neurosurgery Spine ◽

10.3171/2017.11.spine17819 ◽

2018 ◽

Vol 29 (1) ◽

pp. 10-17 ◽

Cited By ~ 7

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Ankur S. Narain ◽

Fady Y. Hijji ◽

Daniel D. Bohl ◽

...

Keyword(s):

Controlled Trial ◽

Anterior Cervical Discectomy ◽

Retropharyngeal Abscess ◽

Cervical Discectomy ◽

Air Index ◽

Estimated Blood Loss ◽

Patient Reported ◽

Chi Square Analysis ◽

The Impact ◽

Single Blind

OBJECTIVEIntraoperative local steroid application has been theorized to reduce swelling and improve swallowing in the immediate period following anterior cervical discectomy and fusion (ACDF). Therefore, the purpose of this study was to quantify the impact of intraoperative local steroid application on patient-reported swallow function and swelling after ACDF.METHODSA prospective, randomized single-blind controlled trial was conducted. A priori power analysis determined that 104 subjects were needed to detect an 8-point difference in the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire score. One hundred four patients undergoing 1- to 3-level ACDF procedures for degenerative spinal pathology were randomized to Depo-Medrol (DEPO) or no Depo-Medrol (NODEPO) cohorts. Prior to surgical closure, patients received 1 ml of either Depo-Medrol (DEPO) or saline (NODEPO) applied to a Gelfoam carrier at the surgical site. Patients were blinded to the application of steroid or saline following surgery. The SWAL-QOL questionnaire was administered both pre- and postoperatively. A ratio of the prevertebral swelling distance to the anteroposterior diameter of each vertebral body level was calculated at the involved levels ± 1 level by using pre- and postoperative lateral radiographs. The ratios of all levels were averaged and multiplied by 100 to obtain a swelling index. An air index was calculated in the same manner but using the tracheal air window diameter in place of the prevertebral swelling distance. Statistical analysis was performed using the Student t-test and chi-square analysis. Statistical significance was set at p < 0.05.RESULTSOf the 104 patients, 55 (52.9%) were randomized to the DEPO cohort and 49 (47.1%) to the NODEPO group. No differences in baseline patient demographics or preoperative characteristics were demonstrated between the two cohorts. Similarly, estimated blood loss and length of hospitalization did not differ between the cohorts. Neither was there a difference in the mean change in the scaled total SWAL-QOL score, swelling index, and air index between the groups at any time point. Furthermore, no complications were observed in either group (retropharyngeal abscess or esophageal perforation).CONCLUSIONSThe results of this prospective, randomized single-blind study did not demonstrate an impact of local intraoperative steroid application on patient-reported swallowing function or swelling following ACDF. Neither did the administration of Depo-Medrol lead to an earlier hospital discharge than that in the NODEPO cohort. These results suggest that intraoperative local steroid administration may not provide an additional benefit to patients undergoing ACDF procedures.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: Class I.Clinical trial registration no.: NCT03311425 (clinicaltrials.gov)

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