(I-539) Characterizing the Effect of Surgical Approach and the Success of Deformity Correction on the Perioperative Quality of Swallowing in Patients Undergoing Corrective Surgery for Cervical Deformity
Resident Physician NYU Langone Health Valley Stream, New York, United States
Introduction: There remains a paucity of literature evaluating the perioperative quality of swallowing among the various approaches to the cervical spine, as well as the success of cervical deformity(ACD) correction.
Methods: ACD patients with three-month(3M) data were included. Dysphagia was defined as any complication related to patient-reported difficulty swallowing, that required: evaluation from a speech language pathologist and/or otolaryngologist and lengthened hospital stay. Clinical deterioration was defined as scoring an MCID of 8 points higher in SWAL-QOL by 3M. Patients were stratified based on surgical approach. Univariate analysis assessed patient characteristics, dysphagia rates, SWAL-QOL scores/improvement at baseline and 3M. ANCOVA and multivariable regression analysis controlling for age, gender, levels fused, baseline deformity(cSVA and TS-CL) and delayed extubation, evaluated the groups based on the 3M difference in SWAL-QOL scores, along with correlation with radiographic improvement.
Results: 19 ACD patients included. By surgical approach, 26% anterior-only, 35% posterior-only, and 36% combined. Patients with delayed extubation were more likely to develop dysphagia and require evaluation(OR: 4.7, 95% CI [1.9-11.7]; p<.001). A total of 22 patients(10.0%) reported dysphagia postoperatively(3 anterior, 1 posterior, 18 combined; p<.001). Patients developing dysphagia also had higher operative times and more superior upper-instrumented vertebra(UIV), although levels fused and EBL was not different. Adjusted analysis revealed patients undergoing a combined approach were still more likely to develop dysphagia than either posterior or anterior approaches. However, timing to resolution of dysphagia was shortest for patients undergoing a combined procedure(7.9 days vs. average of 14.9 days). When examining patients with low and high SWAL-QOL scores at three months, cSVA, C2-T3, and C2-slope showed significant differences between groups. Correlation between improvement in McGregor’s slope and the Fear Swallow domain, as well as TS-CL and Mental and Fatigue domains. Burden domain was correlated with improvement in 5 of the 6 radiographic parameters analyzed(C2-slope, cSVA, C2-C7Lordosis, MGS, and TS-CL).
Conclusion : The combined anterior-posterior approach was associated with higher rates of dysphagia, but much faster recovery(7.9 days on average) compared to the dysphagia reported in anterior and posterior approaches. Preliminary data suggests more successful deformity correction, using improved radiographic markers as a surrogate, may be associated with improved quality of perioperative swallowing.
