Wednesday, November 19, 2014
J Spinal Discord Tech. 2014 Aug 18. [Epub ahead of print]
Kowalczyk I, Ryu WH, Rabin D, Arango M, Duggal N.
To determine whether continuous monitoring and adjustment of the ETTCP to 15mm Hg during ACSS would alter the incidence of post-operative dysphagia.
Post-operative dysphagia is a recognized potential complication of anterior cervical spine surgery (ACSS). Recent findings on preventive measures suggest certain intra-operative practices may minimize this complication.
Fifty patients undergoing ACSS, arthroplasty or fusion, completed routine lateral cervical preoperative plain films and questionnaires (Dysphagia Disability Index (DDI), Bazaz-Yoo Dysphagia Score (BYDS) and SF-36). Patients were randomized into 2 groups: treatment group with ETTCP maintained at 15mm Hg and control group with cuff pressure monitored without manipulation. Radiographs and questionnaires were obtained at 24 hours, 6 weeks, 3 and 6 months post-surgery to assess soft-tissue thickness and rates of dysphagia.
There were no significant differences between the groups in the soft-tissue thickness or questionnaire scores at any time point (P>0.05). Within-group analysis revealed treatment and control groups had a significantly higher 24-hour post-operative soft-tissue thickness and questionnaire scores compared to follow-up measurements (P<0.05). In the pooled group (n=50), the 24-hour post-operative DDI, BYDS and soft-tissue thickness were significantly higher compared to all other time points (P<0.01). DDI scores>=10 related to dysphagia were in 59% of patients at 24 hours, 35% at 6 weeks, 24% at 3 months and 18% at 6 months.
This study suggests decreased ETTCP has no effect on the prevalence of dysphagia. The incidence of dysphagia decreases over time and normalizes by 6 months post surgery.
© 2014 Lippincott Williams & Wilkins, Inc.
Read the Article in PubMed