Abstract：
OBJECTIVE: The goal of this study was to compare rates of dysphagia and patient-reported outcomes (PROs) following long-segment (≥ 3 levels) anterior cervical spinal fusion (ACF) and posterior cervical spinal fusion (PCF) at 3 and 12 months postoperatively. PROs were also compared for patients with dysphagia versus those without dysphagia.
METHODS: A prospectively collected quality improvement database was used to identify patients who had a long-segment cervical spinal fusion. Cohorts were divided into ACF and PCF groups. Eating Assessment Tool-10 scores and PROs were obtained for all patients preoperatively and at 3 and 12 months postoperatively to compare. Multivariate analysis was also performed to evaluate risk factors for dysphagia.
RESULTS: A total of 132 patients met the inclusion criteria, 77 of whom had undergone ACF and 55 of whom had undergone PCF. Dysphagia rates between ACF and PCF cohorts were similar at baseline (13.0% vs 18.2%, p = 0.4). New-onset dysphagia rates were also comparable at 3-month follow-up (39.7% vs 23.1%, p = 0.08) and 12-month follow-up (32.6% vs 32.4%, p > 0.99). Patients who underwent PCF had worse Neck Disability Index (NDI) scores at 3 months than did patients with ACF (13.67 ± 9.49 vs 10.55 ± 6.24, respectively; p = 0.03). There were significantly higher NDI scores for patients with dysphagia at 3 months in both the ACF and PCF groups and at 12 months for those in the PCF group. Analogously, EuroQol-5 Dimensions scores were worse for patients with dysphagia; however, this was only significant for patients in the ACF group at 3 months. There were no significant risk factors for the development of dysphagia found on multivariate analysis.
CONCLUSIONS: Similar rates and severity of dysphagia were seen following ACF and PCF at 3- and 12-month follow-up. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than the surgical approach. However, the ACF cohort was significantly younger, and this may have partially accounted for the findings. PROs were also compared for patients with and without dysphagia, demonstrating worsened outcomes in some domains for patients who presented with dysphagia at 3- and 12-month follow-up. This suggests that dysphagia may be associated with a decreased quality of life after cervical fusion.
METHODS: A prospectively collected quality improvement database was used to identify patients who had a long-segment cervical spinal fusion. Cohorts were divided into ACF and PCF groups. Eating Assessment Tool-10 scores and PROs were obtained for all patients preoperatively and at 3 and 12 months postoperatively to compare. Multivariate analysis was also performed to evaluate risk factors for dysphagia.
RESULTS: A total of 132 patients met the inclusion criteria, 77 of whom had undergone ACF and 55 of whom had undergone PCF. Dysphagia rates between ACF and PCF cohorts were similar at baseline (13.0% vs 18.2%, p = 0.4). New-onset dysphagia rates were also comparable at 3-month follow-up (39.7% vs 23.1%, p = 0.08) and 12-month follow-up (32.6% vs 32.4%, p > 0.99). Patients who underwent PCF had worse Neck Disability Index (NDI) scores at 3 months than did patients with ACF (13.67 ± 9.49 vs 10.55 ± 6.24, respectively; p = 0.03). There were significantly higher NDI scores for patients with dysphagia at 3 months in both the ACF and PCF groups and at 12 months for those in the PCF group. Analogously, EuroQol-5 Dimensions scores were worse for patients with dysphagia; however, this was only significant for patients in the ACF group at 3 months. There were no significant risk factors for the development of dysphagia found on multivariate analysis.
CONCLUSIONS: Similar rates and severity of dysphagia were seen following ACF and PCF at 3- and 12-month follow-up. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than the surgical approach. However, the ACF cohort was significantly younger, and this may have partially accounted for the findings. PROs were also compared for patients with and without dysphagia, demonstrating worsened outcomes in some domains for patients who presented with dysphagia at 3- and 12-month follow-up. This suggests that dysphagia may be associated with a decreased quality of life after cervical fusion.
摘要：
目的：本研究的目的是比较长节段（≥3级）颈椎前路融合（ACF）和颈椎后路融合（PCF）术后3个月和12个月的吞咽困难发生率和患者报告的预后（PROs）。还比较了吞咽困难患者与无吞咽困难患者的PRO。
方法：使用前瞻性收集的质量改进数据库来识别长节段颈椎融合术患者。队列分为ACF和PCF组。对所有患者术前以及术后3个月和12个月的饮食评估工具-10评分和PRO进行比较。还进行了多因素分析以评估吞咽困难的危险因素。
结果：共有132名患者符合纳入标准，其中77人接受了ACF，55人接受了PCF。ACF和PCF队列之间的吞咽困难率在基线时相似(13.0%vs18.2%,p=0.4)。在3个月的随访中，新发吞咽困难的发生率也相当（39.7%vs23.1%，p=0.08）和12个月随访（32.6%vs32.4%，p>0.99）。接受PCF的患者在3个月时的颈部残疾指数（NDI）评分比接受ACF的患者差（分别为13.67±9.49和10.55±6.24；p=0.03）。ACF和PCF组的吞咽困难患者在3个月时以及PCF组的12个月时的NDI评分均显着较高。类似地,吞咽困难患者的EuroQol-5Dimensions评分较差；然而，这仅对ACF组患者在3个月时有意义.在多变量分析中没有发现发生吞咽困难的重要危险因素。
结论：在3个月和12个月的随访中，ACF和PCF的吞咽困难发生率和严重程度相似。这表明颈椎融合手术后的长期吞咽困难可能是由于融合而不是手术方法引起的结构变化。然而,ACF队列明显年轻，这可能部分解释了调查结果。还比较了有和没有吞咽困难的患者的PRO，在3个月和12个月的随访中,出现吞咽困难的患者在某些领域的结局恶化.这表明吞咽困难可能与宫颈融合后生活质量下降有关。
方法：使用前瞻性收集的质量改进数据库来识别长节段颈椎融合术患者。队列分为ACF和PCF组。对所有患者术前以及术后3个月和12个月的饮食评估工具-10评分和PRO进行比较。还进行了多因素分析以评估吞咽困难的危险因素。
结果：共有132名患者符合纳入标准，其中77人接受了ACF，55人接受了PCF。ACF和PCF队列之间的吞咽困难率在基线时相似(13.0%vs18.2%,p=0.4)。在3个月的随访中，新发吞咽困难的发生率也相当（39.7%vs23.1%，p=0.08）和12个月随访（32.6%vs32.4%，p>0.99）。接受PCF的患者在3个月时的颈部残疾指数（NDI）评分比接受ACF的患者差（分别为13.67±9.49和10.55±6.24；p=0.03）。ACF和PCF组的吞咽困难患者在3个月时以及PCF组的12个月时的NDI评分均显着较高。类似地,吞咽困难患者的EuroQol-5Dimensions评分较差；然而，这仅对ACF组患者在3个月时有意义.在多变量分析中没有发现发生吞咽困难的重要危险因素。
结论：在3个月和12个月的随访中，ACF和PCF的吞咽困难发生率和严重程度相似。这表明颈椎融合手术后的长期吞咽困难可能是由于融合而不是手术方法引起的结构变化。然而,ACF队列明显年轻，这可能部分解释了调查结果。还比较了有和没有吞咽困难的患者的PRO，在3个月和12个月的随访中,出现吞咽困难的患者在某些领域的结局恶化.这表明吞咽困难可能与宫颈融合后生活质量下降有关。
