Dysphagia and Dysphonia in Anterior Cervical Spinal Surgery

Overview

Introduction: The anterior cervical approach is used to treat a variety of spinal disorders; among these, the Smith-Robinson approach is the most commonly used, as it allows access to discs, bony structures, and anterior lesions without directly affecting the spinal cord. Its use has increased as anterior discectomies and fusions are performed more frequently. Among the complications, dysphonia and dysphagia are the most common. Objectives: To describe the prevalence of dysphagia and dysphonia in patients with narrow cervical canal who were treated using an anterior cervical approach at the National Institute of Rehabilitation Materials and Methods: This study will consecutively enroll patients diagnosed with a narrow cervical canal who are treated using an anterior cervical approach at the INRLGII. The presence of dysphagia and dysphonia will be assessed in the postoperative period, at three months, and one year after surgery. Patients will be given rating scales to assess the presence and severity of symptoms during these three time periods. Study design: A prospective, longitudinal, observational, descriptive cohort study. Proposed statistical analysis: Clinical and demographic data will be described using summary measures (mean and median) for quantitative data and measures of dispersion (standard deviation, maximum, and minimum). The normality of the data will be tested using the Shapiro-Wilk test. The t-test will be applied to compare quantitative variables, and Pearson's chi-square test will be used for qualitative variables.

First Stage: Upon admission of patients to the Spine Surgery Service with a prior diagnosis of cervical spinal stenosis, each patient will be informed about the surgical procedure, the type of approach, as well as the surgical risks and possible complications. Second Phase: Once patients agree to participate in the protocol, they will be given two scales. The first will be a vocal disability index, consisting of a 30-item questionnaire designed to assess the impact of speech dysfunction on the patient's daily life. The higher the score, the greater the disability. The second questionnaire is the EAT-10, a verbal, unidimensional, direct-scoring analog self-assessment scale designed to evaluate specific symptoms of dysphagia. It is a five-point scale (0-4 points), where zero (0) indicates the absence of the problem and four (4) indicates that the subject considers it a serious problem; higher scores will indicate a greater perception of dysphagia. Third Phase: This will take place during the postoperative period, approximately on the second or third day of recovery and before the patient begins eating solid foods. The questionnaires will be administered again to identify any differences and/or possible postoperative complications. Afterward, the patient will undergo a swallowing test, which involves inserting an endoscope (similar to a probe) through the nasal passage to the glottis, allowing visualization of the vocal cords. Subsequently, patients will swallow various food consistencies-liquid (water), semisolid (baby food), and solid (1/4 of a cookie)-viewed through a camera, reveal the state of the anatomical structures involved before and after swallowing. Prior to swallowing, the endoscope must be positioned on the soft palate, between the soft palate and the epiglottis, to visualize the base of the tongue and assess the passage of the food bolus into the pharynx; all of this is performed by a speech-language pathologist.