From the Research
Dysphagia after anterior cervical discectomy is primarily caused by retraction and manipulation of the esophagus during surgery, as well as potential complications such as hardware placement and bone cement expulsion, as seen in a case report from 2024 1. The procedure requires displacing the esophagus laterally to access the cervical spine, which can cause tissue trauma, inflammation, and edema. This swelling compresses the esophagus and pharynx, making swallowing difficult. Some key points to consider include:
- Retraction and manipulation of the esophagus during surgery can cause tissue trauma, inflammation, and edema, leading to dysphagia.
- Endotracheal intubation during anesthesia can irritate the pharyngeal and laryngeal structures, contributing to dysphagia.
- The recurrent laryngeal nerve may also be stretched or damaged during retraction, affecting vocal cord function and the swallowing mechanism.
- Postoperative hematoma formation can further compress the esophagus externally.
- Hardware placement, such as plates and screws, may cause mechanical irritation if positioned too anteriorly.
- Bone cement expulsion, as seen in the case report 1, can also cause dysphagia by compressing the esophagus. Most cases of dysphagia are temporary, resolving within 2-6 weeks as inflammation subsides. However, persistent dysphagia beyond 3 months warrants further evaluation to rule out hardware complications or rare esophageal perforation, as highlighted in a study from 2020 2. Management includes soft diet progression, proper hydration, and occasionally swallowing therapy. Preoperative counseling about this common complication helps set appropriate expectations for patients undergoing this procedure. A study from 2021 3 identified risk factors for postoperative dysphagia and dysphonia, including current smoking, previous cervical spine surgery, and preoperative opioid use. Another study from 2019 4 compared patient-centered outcome measures to evaluate dysphagia and dysphonia after anterior cervical discectomy and fusion, and found that the Eating Assessment Tool (EAT-10) and Voice Handicap Index (VHI-10) were reliable and valid measures of postoperative dysphagia and dysphonia.