Is the likelihood of dysphagia different in patients undergoing one-level versus two-level anterior cervical discectomy and fusion?

BACKGROUND CONTEXT Dysphagia following anterior cervical discectomy and fusion (ACDF) is a common complication, the etiology of which has not been established. Given that one potential mechanism for dysphagia is local tissue edema, it is thought that a greater number of operative levels may result in higher dysphagia rates. However, prior reports comparing one-level to two-level ACDF have shown varying results. PURPOSE To determine if there is a difference in dysphagia between one-level and two-level ACDF. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent one- or two-level ACDF with a plate-graft construct by a single-surgeon at a high-volume academic medical center. OUTCOME MEASURES Neck Disability Index, Visual Analog Scale for neck pain and arm pain, Short Form-12 physical and mental health components, and Swallowing Quality of Life (SWAL-QOL) Questionnaire. METHODS Patient demographics, operative data, and patient-reported outcome measures (PROMs; Neck Disability Index, Visual Analog Scale, Short Form-12, and SWAL-QOL) of patients undergoing one- and two-level ACDF were compared using Fisher exact test for categorical variables and Student's t test for continuous variables. Regression analyses were conducted to identify factors associated with 6- and 12-week SWAL-QOL scores in order to determine whether the number of surgical levels impacts these outcomes. RESULTS Fifty-eight patients (22 one-level and 36 two-level ACDF) were included. Patients undergoing two-level fusions were older (54.17+8.67 vs 48.06+10.68 years, p=.02) and had longer operative times (69.08+10.51 vs 53.5+14.35 minutes, p 61.5 minutes had a sensitivity and specificity of 62.1% for worse dysphagia scores at 6 weeks compared with baseline. CONCLUSIONS The results of our study indicate that there is no difference in the degree of postoperative dysphagia in one- versus two-level ACDF. However, other variables associated with increased postoperative dysphagia in our population included younger age, male sex, procedural time >61.5 minutes, and worse preoperative dysphagia. Larger studies are required to confirm these findings and identify additional risk factors for postoperative dysphagia.