Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Purpose The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy

Acta Oto-Laryngologica ◽

10.1080/00016489.2020.1752933 ◽

2020 ◽

Vol 140 (8) ◽

pp. 685-688

Author(s):

Lisa M. Evangelista ◽

Ahmed Bayoumi ◽

Brandon A. Dyer ◽

Rakendu P. Shukla ◽

Shyam D. Rao ◽

...

Keyword(s):

Radiation Therapy ◽

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Swallowing Function ◽

Pharyngeal Wall ◽

Posterior Pharyngeal Wall Thickness ◽

The Relationship

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S194 – Pharyngeal Thickness in Young and Elderly Normal Subjects

Otolaryngology ◽

10.1016/j.otohns.2008.05.368 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P140-P141

Author(s):

Shervin Aminpour ◽

Scott Fuller ◽

Leonard Rebecca ◽

Peter C Belafsky

Keyword(s):

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Normal Subjects ◽

The Elderly ◽

Elderly Subjects ◽

Elderly Persons ◽

Pharyngeal Wall ◽

Posterior Pharyngeal Wall Thickness ◽

Normal Adults ◽

Anterior Posterior

Objectives Previous research has demonstrated pharyngeal size and constriction differences between normal young and elderly adults. Evidence suggests that the pharynx of elderly subjects dilates and does not constrict as well as younger persons. The distance between the larynx and the hyoid at rest is greater in the elderly, as is the anterior-posterior width of the pharynx maximally expanded. We have noticed that the pharynx of elderly persons appears to atrophy with age. The purpose of this investigation was to compare pharyngeal wall thickness in young vs. elderly persons. Methods Videofluoroscopic swallow studies were performed on 82 normal adults under the age of 65 years and on 89 normal adults over the age of 65. Measures of posterior pharyngeal wall thickness (PWT) were determined at rest and at the same point during maximum constriction of the pharynx on a 20-cc bolus swallow. Data were compared with the independent samples t-test. Results No gender differences were identified for the younger or elderly groups. Mean PWT at rest was .40cm (± .08) for the younger group and 30cm (± .08) for the elderly (p <0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08cm (±38) for the younger group and .92cm (±36) for the elderly (p <0.01). Conclusions Data from the current study suggest that the posterior pharyngeal wall is thinner in elderly individuals older than 65 as compared to younger adults. These differences may help explain differences in pharyngeal strength, swallowing efficiency, and safety in the elderly.

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The posterior pharyngeal wall thickness is associated with OSAHS in patients with acromegaly and correlates with IGF-1 levels

Endocrine ◽

10.1007/s12020-018-1631-3 ◽

2018 ◽

Vol 61 (3) ◽

pp. 526-532 ◽

Cited By ~ 4

Author(s):

Xiaopeng Guo ◽

Yumo Zhao ◽

Man Wang ◽

Lu Gao ◽

Zihao Wang ◽

...

Keyword(s):

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Pharyngeal Wall ◽

Posterior Pharyngeal Wall Thickness

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Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants

Neurosurgery ◽

10.1093/neuros/nyab079 ◽

2021 ◽

Author(s):

Won Hyung A Ryu ◽

Dominick Richards ◽

Mena G Kerolus ◽

Adewale A Bakare ◽

Ryan Khanna ◽

...

Keyword(s):

Smoking Status ◽

Posterior Instrumentation ◽

Patient Reported Outcome ◽

Anterior Cervical Discectomy ◽

Successful Outcome ◽

Cervical Discectomy ◽

Structural Allograft ◽

Modifiable Factors ◽

Patient Reported ◽

The Impact

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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Swallowing Function Following Anterior Cervical Discectomy and Fusion With and Without Anterior Plating: A SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment

Neurospine ◽

10.14245/ns.1836188.094 ◽

2019 ◽

Vol 16 (3) ◽

pp. 601-607 ◽

Cited By ~ 4

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Dil V. Patel ◽

Joon S. Yoo ◽

Jordan A. Guntin ◽

...

Keyword(s):

Quality Of Life ◽

Anterior Cervical Discectomy ◽

Radiographic Assessment ◽

Swallowing Function ◽

Cervical Discectomy ◽

Anterior Plating

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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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