gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

22. - 25.10.2019, Berlin

Dysphagia in Standalone versus Conventional Anterior Cervical Discectomy

Meeting Abstract

  • presenting/speaker Christian Fisahn - Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Martin Hoffmann - BG-Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Antonius Antoniadis - Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Jens R. Chapman - Swedish Hospital, Seattle, United States
  • Thomas A. Schildhauer - BG Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Chirurgische Klinik und Poliklinik, Bochum, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB67-385

doi: 10.3205/19dkou623, urn:nbn:de:0183-19dkou6230

Veröffentlicht: 22. Oktober 2019

© 2019 Fisahn et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Dysphagia is an extensively described complication of anterior cervical discectomy and fusion. It has been proposed that mechanical irritation, additional dissection or displacement of the esophagus by plate placement may contribute to a greater incidence of post-operative dysphagia. The aim of this study was to compare dysphagia symptoms and pain severity of standalone cage systems versus interbody devices in combination with an anterior plate.

Methods: A retrospective cohort study identified 377 consecutive patients (stand alone, n=211; plate and cage, n=166) meeting the study criteria between the years 2016 to 2017. Patient-specific characteristics and surgical characteristics and Numeric Pain Rating Scale (NRS) scores were collected preoperatively. Complication and readmission rates, the Dysphagia Disability Index (DDI), and NRS scores were collected at one year and two years post-operatively.

Results and conclusion: Both groups were similar with respect to age, gender, body mass index, smoking status, several comorbidities including the Charlson score, and pre-operative NRS scores (5.3 ± 2.1 versus 5.4 ± 1.9 in the stand alone and plate and cage groups, respectively). Patients in the stand along group were more likely to have a primary diagnosis of radiculopathy and less likely to have the diagnosis of myelopathy. They were more likely to have had prior cervical surgery (22.8% vs 13.3%; p=.02). Patients in the plate and cage group were more likely to have multiple levels of surgery (57.8% versus 34.6%; p<.01) and experienced a longer length of surgery (143 ± 51 minutes versus 108 ± 43 minutes; p<.01). Both groups experienced similar complication and readmission rates. The stand along group experienced a higher rate of symptomatic non-union with reoperation but this did not achieve statistical significance (9% versus 4%; p=.07). There was a significantly greater improvement in neck pain scores in the plate and cage group after one and two years post-surgery compared to the stand alone group (2.3 and 3.1 versus 1.6 and 1.5, respectively; p<.01). Post operative DDI scores were similar at 2 years post-surgery (9.4 ± 11.9 versus 9.5 ± 11.7).

Chronic dysphagia scores are comparable between standalone cage systems and interbody grafts with plating. We observed a greater improvement in neck pain and a lower incidence of nonunion in the group that underwent interbody graft and plate placement at followup. Further research is needed in order to determine factors that may lead to a higher rate of non union for patients undergoing stand alone cage placement.