Comparison of the incidence of patient-reported post-operative dysphagia between ACDF with a traditional anterior plate and artificial cervical disc replacement

Purpose: Compared with anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR) has provided satisfactory clinical results. The incidence of post-operative dysphagia between ACDF with a traditional anterior plate and CDR remains controversial. Considering the limited studies and knowledge in this area, a retrospective study focusing on post-operative dysphagia was conducted. Methods: The Bazaz grading system was used to assess the severity of dysphagia at post-operative intervals including 1 week, 1 month, 3 months, 6 months, 12 months and 24 months respectively. The Chi-square test, Student t-test, Mann-Whitney U tests and Ordinal Logistic regression were used for data analysis when appropriate. Statistical significance was accepted at a probability value of <0.05. Results: Two hundred and thirty-one patients in the CDR group and one hundred and fifty-eight patients in Plate group were included in this study. The total incidences of dysphagia in the CDR and plate group were 36.58% and 60.43% at one week, 29.27% and 38.85% at one month, 21.95% and 31.65% at three months, 6.83% and 17.99% at six months, 5.85% and 14.39% at 12 months, and 4.39% and 10.07% at the final follow-up respectively (All P < 0.05, Mann-Whitney U test). Ordinal Logistic regression analysis showed that female patients, two-level surgery, C4/5 surgery, and anterior cervical plating were significant risk factors for post-operative dysphagia (all P <0.05). Conclusion: Comparing ACDF with a plate, CDR with a Prestige LP can significantly reduce both transient and persistent post-operative dysphagia. Female patients, two-level surgery, C4/5 surgery and anterior cervical plating were associated with a higher incidence of dysphagia. Future prospective, randomized, controlled studies are needed to further validate these findings. (C) 2016 Elsevier B.V. All rights reserved.