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Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperativ...

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Autores principales: Tsalimas, Georgios, Evangelopoulos, Dimitrios Stergios, Benetos, Ioannis S, Pneumaticos, Spiros
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375980/
https://www.ncbi.nlm.nih.gov/pubmed/35978748
http://dx.doi.org/10.7759/cureus.26888
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author Tsalimas, Georgios
Evangelopoulos, Dimitrios Stergios
Benetos, Ioannis S
Pneumaticos, Spiros
author_facet Tsalimas, Georgios
Evangelopoulos, Dimitrios Stergios
Benetos, Ioannis S
Pneumaticos, Spiros
author_sort Tsalimas, Georgios
collection PubMed
description Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate. The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: “dysphagia” and “anterior cervical discectomy and fusion” or “ACDF”. The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded. Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.
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spelling pubmed-93759802022-08-16 Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion Tsalimas, Georgios Evangelopoulos, Dimitrios Stergios Benetos, Ioannis S Pneumaticos, Spiros Cureus Neurosurgery Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate. The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: “dysphagia” and “anterior cervical discectomy and fusion” or “ACDF”. The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded. Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia. Cureus 2022-07-15 /pmc/articles/PMC9375980/ /pubmed/35978748 http://dx.doi.org/10.7759/cureus.26888 Text en Copyright © 2022, Tsalimas et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurosurgery
Tsalimas, Georgios
Evangelopoulos, Dimitrios Stergios
Benetos, Ioannis S
Pneumaticos, Spiros
Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title_full Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title_fullStr Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title_full_unstemmed Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title_short Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion
title_sort dysphagia as a postoperative complication of anterior cervical discectomy and fusion
topic Neurosurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375980/
https://www.ncbi.nlm.nih.gov/pubmed/35978748
http://dx.doi.org/10.7759/cureus.26888
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