Assessment of the self-reported dysphagia in patients undergoing one-level versus two-level cervical disc replacement with the Prestige-LP prosthesis

Objectives: Cervical disc replacement (CDR) has been established as an alternative to anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative pathologies over the past decade. However, swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia after CDR. Currently, there are limited studies focusing on the incidences, severity and associated risk factors for dysphagia after CDR. This paucity, therefore, necessitated this retrospective study on post-operative dysphagia after one- and two-level CDR. Patients and methods: One hundred and fourteen patients underwent one-level CDR and forty eight patients underwent two-level CDR were recruited with a mean follow-up of 21 months (ranging from 14 to 30 months). The prevalence and severity of dysphagia was evaluated by the Bazaz grading system during the follow-up time. Regression analyses were done to identify risk factors associated with post-operative dysphagia after CDR. Results: The overall dysphagia occurrences in the one- and two-level CDR groups were 17.54% and 35.41% at week one, 12.28% and 25% after one month, 9.65% and 18.75% after three months, 6.14% and 14.58% after six months, 4.39% and 6.25% after one year, and 3.51% and 4.17% at the final follow-up, respectively. The identified risk factors for dysphagia after CDR were advanced age, C4/5 surgery, two-level surgery, dC2-C7 angle > - 5 degrees and > 6 mm changes in the prevertebral soft tissue swelling (dPSTS). Conclusion: The patients who experienced two-level CDR may have poor swallowing functions in the early postoperative term. However, these patients also can recover well with increasing length of follow-up. In addition, patients with advanced age, C4/5 surgery, dC2-C7 angle > - 5 degrees and > 6 mm changes in dPSTS may prone to occur dysphagia after CDR.