Risk Factors Associated with Dysphagia after Anterior Surgery in Treatment for Multilevel Cervical Disorder with Kyphosis

Study Design: A retrospective study.Objective: The purpose of this study was to clarify the risk factors associated with dysphagia following anterior surgery treating multilevel cervical disorder with kyphosis based on subgroup of follow-up time.Methods: Totally, 81 patients who suffered from multilevel cervical disorder with kyphosis receiving anterior surgery from July 2018 to June 2020 were reviewed for clinical and radiological outcomes. Patients with dysphagia was defined as dysphagia group and without dysphagia as no-dysphagia group according to follow-up time (1 week, 1-month, 3-month, 6-month and 1-year after surgery). Data was performed to compare between the patients with and without dysphagia.Results: In our study, the occurrence of dysphagia was 67.9%, 44.4%, 34.6%，25.9% and 14.8% at the time of 1 week, 1-month, 3-month, 6-month, and 1 -year after surgery, respectively. Our findings showed that a history of smoking, lower preoperative Swallowing Quality of Life (SWAL-QOL) score, post-operative Cobb angle of C2-7 and change of Cobb angle of C2-7 were associated with dysphagia within 3-month after surgery. Furthermore, a history of smoking, lower preoperative SWAL-QOL score, and post-operative Cobb angle of C2-7 were linked with dysphagia within 6-month after surgery. However, a history of smoking and lower preoperative SWAL-QOL score were found to be risk factors related with dysphagia at at any follow-up.Conclusions: In the present study, many factors were related with dysphagia during 3-month after surgery. What’s more, a history of smoking and lower preoperative SWAL-QOL score were associated with dysphagia at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffer from dysphagia after anterior surgery in treatment of multilevel cervical disorder with kyphosis.

Anterior instrumentation surgery for the treatment of Lenke type 1AR curve patterns

OBJECTIVE Previous studies have demonstrated that Lenke lumbar modifier A contains 2 distinct types (AR and AL), and the AR curve pattern is likely to develop adding-on (i.e., a progressive increase in the number of vertebrae included within the primary curve distally after posterior surgery). However, the results of anterior surgery are unknown. The purpose of this study was to present the surgical results in a cohort of patients undergoing scoliosis treatment for type 1AR curves and to compare anterior and posterior surgeries to consider the ideal indications and advantages of anterior surgery for type 1AR curves. METHODS Patients with a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) and a minimum 2-year postoperative follow-up were included. The incidence of adding-on and radiographic data were compared between the anterior and posterior surgery groups. The numbers of levels between the end, stable, neutral, and last touching vertebra to the lower instrumented vertebra (LIV) were also evaluated. RESULTS Forty-four patients with a mean follow-up of 57 months were included. There were 14 patients in the anterior group and 30 patients in the posterior group. The main thoracic Cobb angle was not significantly different between the groups preoperatively and at final follow-up. At final follow-up, the anterior group had significantly less tilting of the LIV than the posterior group (−0.8° ± 4.5° vs 3° ± 4°). Distal adding-on was observed in no patient in the anterior group and in 6 patients in the posterior group at final follow-up (p = 0.025). In the anterior group, no LIV was set below the end vertebra, and all LIVs were set above last touching vertebra. The LIV was significantly more proximal in the anterior group than in the posterior surgery patients without adding-on for all reference vertebrae (p < 0.001). CONCLUSIONS This is the first study to investigate the surgical results of anterior surgery for Lenke type 1AR curve patterns, and it showed that anterior surgery for the curves could minimize the distal extent of the instrumented fusion without adding-on. This would leave more mobile disc space below the fusion.

T1–T2 disc herniation: Report of four cases and review of the literature

Background: Symptomatic T1–T2 disc herniations are rare and, in most cases, are located posterolaterally. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Case Description: Here, we reviewed four cases of symptomatic T1–T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. The latter two cases had posterolateral discs contributing to a Brown-Sequard syndrome and radiculopathy, respectively; one patient required a transfacet pedicle-sparing procedure, while the second case was managed conservatively. All surgically treated patients recovered fully. Conclusions: We reviewed 4 cervical T1–T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc.