Background & Aims

Dysphagia is related to swallowing pain and common symptoms after anterior cervical discectomy and fusion (ACDF). Although hypopharyngeal muscle weakness is suspected to play a role, there is insufficient evidence regarding the participation of other muscle groups. This study aimed to explore the correlation between swallowing muscle strength and dysphagia symptoms.

Methods

We evaluated swallowing pain in 43 post-ACDF patients using high-resolution impedance manometry (HRIM), Videofluoroscopic Swallow Study (VFSS) and the eating assessment tool (EAT-10). HRIM evaluates the swallowing muscle strength, including the hypopharyngeal muscles, using hypopharyngeal mean peak pressure. A higher Swallowing Risk Index (SRI) indicates increasing aspiration risk. VFSS could assessed airway invasion of fluid bolus. Dysphagia assessment was conducted using food textures of 0 (water), 3 and 4 on the International Dysphagia Diet Standardization Initiative (IDDSI) scale. As the IDDSI scale increases, the viscosity of the food becomes higher. Patients were categorized as having or not having swallowing pain, with the EAT-10 scores utilizing level 3 as the threshold.

Results

There were 29 patients with dysphagia and 14 patients without dysphagia. At IDDSI level 0, patients with dysphagia had lower hypopharyngeal mean peak pressure (65.1 vs. 140.8 mmHg) and a significantly higher SRI (4.5 vs. 25.3). Similar trends were observed at IDDSI levels 3 and 4, with lower hypoPeakP values in dysphagia patients, but there was no significant increase in SRI. No instances of food bolus entry into the airway were identified during VFSS across all three IDDSI levels.

Conclusions

Patients experienced dysphagia after ACDF exhibited reduced hypopharyngeal muscle strength and an increased risk of aspiration when they drink fluid. If postoperative patients experience dysphagia and have an EAT-10 score greater than or equal to three, they should be provided with patient education on sip and swallow techniques, and early initiation of oropharyngeal dysphagia rehabilitation is recommended.

References

1. Lai CJ, Cheng YJ, Lai DM, Wu CY, Chang WT, Tsuang FY. Applying High-Resolution Impedance Manometry for Detecting Swallowing Change in Anterior Cervical Spine Surgery Patients. Front Surg. 2022;9:851126.
2. Cock C, Omari T. Diagnosis of Swallowing Disorders: How We Interpret Pharyngeal Manometry. Curr Gastroenterol Rep. 2017;19:11.

Presenting Author

Chih-Jun Lai

Poster Authors

Chih-Jun Lai

MD

National Taiwan University Hospital

Lead Author

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