Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury

Min Cheol Chang; Dae Yeong Kim; Jin-Woo Choi; Ho Yong Choi; Jin-Sung Park; Donghwi Park

doi:10.3390/jcm12093227

Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury

J Clin Med. 2023 Apr 30;12(9):3227. doi: 10.3390/jcm12093227.

Authors

Min Cheol Chang¹, Dae Yeong Kim², Jin-Woo Choi², Ho Yong Choi³, Jin-Sung Park⁴, Donghwi Park⁵

Affiliations

¹ Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu 42415, Republic of Korea.
² Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea.
³ Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea.
⁴ Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41944, Republic of Korea.
⁵ Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayangro 99, Dong gu, Daegu 41199, Republic of Korea.

Abstract

Introduction: Early detection and management of dysphagia are essential for preventing aspiration pneumonia and reducing mortality in patients with cervical spinal cord injury (C-SCI). In this study, we identified risk factors for dysphagia in patients with C-SCI by analyzing the correlation between the clinical factors and the severity of dysphagia, not the presence or absence of dysphagia. Combined with the analysis results of previous studies, we thought that this additional analysis method could more accurately reveal the risk factors for dysphagia in patients with C-SCI.

Methods: The presence and severity of dysphagia in patients with C-SCI was evaluated using a modified videofluoroscopic dysphagia scale (mVDS) and penetration-aspiration scale (PAS). All included patients with C-SCI performed a video fluoroscopic swallowing study (VFSS). Clinical factors such as age, sex, the presence of tracheostomy, spinal cord independence measure (SCIM), pulmonary function test (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), American Spinal Cord Injury Association (ASIA) score, Berg Balance Scale (BBS), and operation method were investigated.

Results: In the multivariate regression analysis, the anterior surgical approach was the only clinical factor that had a significant correlation in both mVDS and PAS, which represents the severity of dysphagia in C-SCI patients (p < 0.05).

Conclusion: The anterior surgical approach was correlated with the severity of dysphagia in patients with C-SCI. Considering this, as one of the risk factors affecting dysphagia in patients with C-SCI, surgical method may also need to be considered. Additionally, we recommend that clinicians should pay particular attention to the potential for development of dysphagia in patients who received anterior cervical surgery. However, further prospective studies with larger sample sizes are needed for more accurate generalization.

Keywords: deglutition; dysphagia; spinal cord injury; tracheostomy.

Grants and funding

This study was supported by a National Research Foundation of Korea grant funded by the Korean government (grant no. NRF-2022R1F1A1072553).