| | Dysphonia and Dysphagia following Anterior Cervical Diskectomy and Fusion (ACD&F)
Purpose
To determine the clinical course and outcomes of post op complications for patients undergoing ACD&F
Background
ACD&F is a surgical procedure used to correct symptomatic spondylosis (nonspecific degeneration of the spine). The exact cause of this spinal degeneration is not known. The most common presenting symptom is pain, which in some cases interferes with the patient being able to perform their day to day activities. Treatment for this condition involves removing the affected discs in the neck and replacing them with a piece of bone in order to maintain neck stability.
Gundersen Lutheran performs approximately 80 ACD&F procedures yearly to correct this spinal degeneration with the goal of relieving pain and allowing patients to return to their previous lifestyle. Following this procedure it is not uncommon for patients to experience problems with their voice and swallowing due to swelling, nerve trauma or infection. These usually resolve or improve on their own within 6-10 months after surgery. In cases where these symptoms do not resolve treatment can vary from conservative therapy such resting the voice to surgical intervention.
Aims
To establish a complication rate for dysphonia and dysphagia following ACD&F at Gundersen Lutheran and compare it with rates published in the literature. This will provide a baseline against which future improvement efforts can be directed.
Changes
None
Methods/Measures
A retrospective study of 200 consecutive patients who underwent ACD&F procedure at Gundersen Lutheran between January 2002 and February 2004 was completed. Charts were reviewed to identify patients with post op voice (dysphonia) and/or swallowing (dysphagia) disorders. Patients with post op voice and/or swallowing disorders that also have gastroesophageal reflux disorder (GERD) were excluded from the study.
Results
Conclusions
Gundersen Lutheran’s Division of Neurosurgery confidence interval is totally within the reported incidence range for complications of dysphonia and dysphagia following ACD&F.
Impact
Post operative complications not only add to healthcare costs but can impact the patients ability to perform their day to activities independently. When undergoing surgical procedures, patients assume they will be performed safely and appropriately. Gundersen Lutheran’s Division of Neurosurgery is able to demonstrate a complication rate following ACD&F similar to those found in the literature.
Next Steps
The Division of Neurosurgery will continue to monitor the dysphonia and dysphagia rate following ACD&F at Gundersen Lutheran.
References
1. Baron EM, Soliman AS, Simpson L, Gaughan JP, Young WF. Dysphagia, Hoarseness and Unilateral True Vocal Fold Motion Impairment Following Anterior Cervical Diskectomy and Fusion. Annals of Otology Rhinology and Laryngology. 2003: 921-926.
2. Martin RE, Neary MA, Diamant NE. Dysphagia Following Anterior Cervical Spine Surgery. Dysphagia. 1997; 12: 2-8.
3. Winslow CP, Winslow TJ, Wax MK. Dysphonia and Dysphagia Following the Anterior Approach to the Cervical Spine. Archives of Otolaryngology Head and Neck Surgery. 2001; 127: 51-55.
4. Beutler WJ, Sweeney CA, Connolly PJ. Recurrent Laryngeal Nerve Injury with Anterior Cervical Spine Surgery: Risk with Laterality of Surgical Approach. SPINE. 2001; 12: 1337-1341.
Activity Leader
Tony Sanchez, PA-C Department of Neurosurgery
Acknowledgments
David E. Hartman, Ph.D., BC-NCD
Head, Speech Pathology, Department of Neurology
Clinical Director, Speech Pathology Services
Pat Kohner, QPI
Jeff Falk, Biostatistics |