Manual preoperative tracheal retraction exercise decreases the occurrence of postoperative oropharyngeal dysphagia after anterior cervical discectomy and fusion

Objective: Preoperative tracheal retraction exercise (TRE) to minimize the occurrence of postoperative oropharyngeal dysphagia after anterior cervical spine surgery. Methods: A total of 220 patients admitted for elective anterior cervical spine surgery from January 2013 to December 2014 were retrospectively reviewed. The patients were allocated into two groups: TRE group and control group (without TRE). Modified dysphagia scoring system (MDSS) was used for evaluating the presence and severity of dysphagia symptoms at 1 week and 1, 3, and 6 months after surgery. Demographics such as age, gender, smoking, type of procedure, number of levels operated, duration of surgery, intraoperative blood loss, and instrumentation were analyzed. The clinical outcomes in both groups were compared with Neck Disability Index (NDI), Visual Analogue Scale (VAS) for arm and neck pain, and Odom's criteria for global outcome. Results: In the first week postoperatively, 86 patients (39.1%) developed dysphagia, which decreased to 72 (32.7%), 5 (2.3%), and 4 (1.8%) after 1, 3, and 6 months, respectively. The patients who received the TRE prior to surgery had significantly better MDSS scores (p = 0.032 for second-level, 0.022 for third-level, and 0.009 for fourth-level fusions) than control group patients who did not receive TRE at the first week of surgery. At the 1-month follow-up, the followed-up patients for second- to fourth-level fusions in the TRE group had improved MDSS scores than those in the control group (p = 0.041 for second-level, 0.025 for third-level, and 0.0011 for fourth-level fusions). MDSS scores showed no significant difference between both the groups at 1 and 3 months postoperatively for single level anterior cervical fusion. NDI and VAS scores didn't yield any significant difference. Global outcome by Odom's criteria was 88.6%. Conclusion: Preoperative TRE can significantly reduce the occurrence of postoperative dysphagia after ACDF surgery. During follow-up, the incidence of postoperative dysphagia was significantly lower and had resolved at 3 months in all patients.