Skip to main content
SpringerLink
Log in

Postoperative Sore Throat Helps Predict Swallowing Disturbance on Postoperative Day 30 of Anterior Cervical Spine Surgery: A Secondary Exploratory Analysis of a Randomized Clinical Trial of Tracheal Intubation Modes

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Nasotracheal intubation benefits dysphonia recovery after anterior cervical spine surgery (ACSS). The aim of the present study was to investigate the effect of tracheal intubation modes on post-ACSS swallowing function and identify factors associated with deglutition on postoperative day 30 (POD 30). Adult patients were randomized to receive either nasotracheal or orotracheal intubation during surgery. A numerical rating scale (NRS) was used to assess postoperative sore throat, and the Bazaz grading system was used to assess the severity of swallowing disturbance. The primary endpoints were the effect of tracheal intubation modes on postoperative sore throat and deglutition. Thereafter, we further elucidated the predictors of swallowing disturbance on POD 30. Postoperative sore throat and swallowing disturbance did not differ between the nasotracheal and orotracheal intubation groups. A secondary dataset analysis revealed that among 108 patients with complete follow-up until POD 30, 71 (65.7%) presented complete recovery without swallowing disturbance, whereas 37 (34.3%) presented varying degrees of swallowing disturbance. Receiver operating characteristic curve analysis indicated that the NRS score for sore throat predicted a swallowing disturbance-free status on POD 30. The optimal cutoff values were ≤ 4 and ≤ 2 on PODs 1 and 2, respectively. The adjusted odds ratio (OR) for independent predictors was a sore throat NRS score of ≤ 4 on POD 1 (OR 3.2; 95% CI 1.29–7.89; P = 0.012) and score of ≤ 2 on POD 2 (OR 6.67; 95% CI 2.41–18.47; P < 0.001). Therefore, tracheal intubation mode did not affect the incidence of post-ACSS swallowing disturbance, and the severity of sore throat on PODs 1 and 2 could predict a swallowing disturbance-free status on POD 30.

The trial was registered at clinicaltrials.gov (Trial No. NCT03240042, date of registration 10/17/2017).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27:2453–8. https://doi.org/10.1097/00007632-200211150-00007.

    Article  Google Scholar 

  2. Mehra S, Heineman TE, Cammisa FP Jr, Girardi FP, Sama AA, Kutler DI. Factors predictive of voice and swallowing outcomes after anterior approaches to the cervical spine. Otolaryngol Head Neck Surg. 2014;150:259–65. https://doi.org/10.1177/0194599813515414.

    Article  PubMed  Google Scholar 

  3. Mendoza-Lattes S, Clifford K, Bartelt R, Stewart J, Clark CR, Boezaart AP. Dysphagia following anterior cervical arthrodesis is associated with continuous, strong retraction of the esophagus. J Bone Jt Surg Am. 2008;90a:256–63. https://doi.org/10.2106/Jbjs.G.00258.

    Article  Google Scholar 

  4. Sperry RJ, Johnson JO, Apfelbaum RI. Endotracheal-tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system. Anesth Analg. 1993;76:1318–21. https://doi.org/10.1213/00000539-199376060-00023.

    Article  CAS  PubMed  Google Scholar 

  5. Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine (Phila Pa 1976). 2000;25:2906–12. https://doi.org/10.1097/00007632-200011150-00012.

    Article  CAS  Google Scholar 

  6. Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014;14:2246–60. https://doi.org/10.1016/j.spinee.2014.03.030.

    Article  PubMed  Google Scholar 

  7. Kowalczyk I, Ryu WH, Rabin D, Arango M, Duggal N. Reduced endotracheal tube cuff pressure to assess dysphagia after anterior cervical spine surgery. J Spinal Disord Tech. 2015;28:E552–8. https://doi.org/10.1097/BSD.0000000000000033.

    Article  PubMed  Google Scholar 

  8. In ‘t Veld BA, Rettig TCD, de Heij N, de Vries J, Wolfs JFC, Arts MP. Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial. Eur Spine J. 2019;28:353–61. https://doi.org/10.1007/s00586-018-5798-3.

    Article  PubMed  Google Scholar 

  9. Riley LH III, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976). 2005;30:2564–9. https://doi.org/10.1097/01.brs.0000186317.86379.02.

    Article  Google Scholar 

  10. Fassett DR, Apfelbaum RI. Vocal cord paralysis after anterior cervical spine surgery. In: An HS, Jenis LG, editors. Complications of spine surgery: treatment and prevention. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 23–30.

    Google Scholar 

  11. Hahn FW Jr, Martin JT, Lillie JC. Vocal-cord paralysis with endotracheal intubation. Arch Otolaryngol. 1970;92:226–9. https://doi.org/10.1001/archotol.1970.04310030016005.

    Article  PubMed  Google Scholar 

  12. Huang WC, Tan EC, Chang CC, Kuo YH, Hsu TJ, Chang WK, Huang SS, Chen PT, Chu YC. Effect of tracheal intubation mode on cuff pressure during retractor splay and dysphonia recovery after for anterior cervical spine surgery: a randomized clinical trial. Spine (Phila Pa 1976). 2020;45:565–72. https://doi.org/10.1097/BRS.0000000000003339.

    Article  CAS  Google Scholar 

  13. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG, Consort. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10:28–55. https://doi.org/10.1016/j.ijsu.2011.10.001.

    Article  PubMed  Google Scholar 

  14. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::aid-cncr2820030106%3e3.0.co;2-3.

    Article  CAS  PubMed  Google Scholar 

  15. Anderson KK, Arnold PM. Oropharyngeal dysphagia after anterior cervical spine surgery: a review. Glob Spine J. 2013;3:273–86. https://doi.org/10.1055/s-0033-1354253.

    Article  Google Scholar 

  16. Carucci LR, Turner MA, Yeatman CF. Dysphagia secondary to anterior cervical fusion: radiologic evaluation and findings in 74 patients. Am J Roentgenol. 2015;204:768–75. https://doi.org/10.2214/AJR.14.13148.

    Article  Google Scholar 

  17. Papavero L, Heese O, Klotz-Regener V, Buchalla R, Schroder F, Westphal M. The impact of esophagus retraction on early dysphagia after anterior cervical surgery: does a correlation exist? Spine (Phila Pa 1976). 2007;32:1089–93. https://doi.org/10.1097/01.brs.0000261627.04944.cf.

    Article  Google Scholar 

  18. Chin KR, Eiszner JR, Adams SB Jr. Role of plate thickness as a cause of dysphagia after anterior cervical fusion. Spine (Phila Pa 1976). 2007;32:2585–90. https://doi.org/10.1097/BRS.0b013e318158dec8.

    Article  Google Scholar 

  19. Kepler CK, Rihn JA, Bennett JD, Anderson DG, Vaccaro AR, Albert TJ, Hilibrand AS. Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis. Spine J. 2012;12:639–44. https://doi.org/10.1016/j.spinee.2012.03.024.

    Article  PubMed  Google Scholar 

  20. Lee SH, Kim KT, Suk KS, Park KJ, Oh KI. Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study. Spine (Phila Pa 1976). 2011;36:2286–92. https://doi.org/10.1097/BRS.0b013e318237e5d0.

    Article  Google Scholar 

  21. Song KJ, Lee SK, Ko JH, Yoo MJ, Kim DY, Lee KB. The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis. Spine J. 2014;14:2954–8. https://doi.org/10.1016/j.spinee.2014.06.005.

    Article  PubMed  Google Scholar 

  22. Ian Dhar S, Wegner AM, Rodnoi P, Wuellner JC, Mehdizadeh OB, Shen SC, Nachalon Y, Nativ-Zeltzer N, Belafsky PC, Klineberg EO. Fluoroscopic swallowing abnormalities in dysphagic patients following anterior cervical spine surgery. Ann Otol Rhinol Laryngol. 2020. https://doi.org/10.1177/0003489420929046.

    Article  PubMed  Google Scholar 

  23. Skeppholm M, Ingebro C, Engstrom T, Olerud C. The Dysphagia Short Questionnaire: an instrument for evaluation of dysphagia: a validation study with 12 months’ follow-up after anterior cervical spine surgery. Spine (Phila Pa 1976). 2012;37:996–1002. https://doi.org/10.1097/BRS.0b013e31823a7a5b.

    Article  Google Scholar 

  24. Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF, Francis DO. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus. 2017;30:1–23. https://doi.org/10.1093/dote/dow028.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE. Dysphagia rates after anterior cervical diskectomy and fusion: a systematic review and meta-analysis. Glob Spine J. 2017;7:95–103. https://doi.org/10.1055/s-0036-1583944.

    Article  Google Scholar 

  26. Tian W, Yu J. The role of C2–C7 and O-C2 angle in the development of dysphagia after cervical spine surgery. Dysphagia. 2013;28:131–8. https://doi.org/10.1007/s00455-012-9421-1.

    Article  PubMed  Google Scholar 

  27. Yang Y, Ma L, Liu H, Xu M. A meta-analysis of the incidence of patient-reported dysphagia after anterior cervical decompression and fusion with the Zero-Profile Implant System. Dysphagia. 2016;31:134–45. https://doi.org/10.1007/s00455-015-9681-7.

    Article  PubMed  Google Scholar 

  28. Deng Y, Huang K, Liu H, Chen H, Rong X, Gong Q, Hong Y, Yang Y. An absorbable collagen biomembrane help improve swallowing function after anterior cervical spine surgery. Dysphagia. 2019. https://doi.org/10.1007/s00455-019-10083-0.

    Article  PubMed  Google Scholar 

  29. Min Y, Kim WS, Kang SS, Choi JM, Yeom JS, Paik NJ. Incidence of dysphagia and serial videofluoroscopic swallow study findings after anterior cervical discectomy and fusion: a prospective study. Clin Spine Surg. 2016;29:E177–81. https://doi.org/10.1097/BSD.0000000000000060.

    Article  PubMed  Google Scholar 

  30. Kang SH, Kim DK, Seo KM, Lee SY, Park SW, Kim YB. Swallowing function defined by videofluoroscopic swallowing studies after anterior cervical discectomy and fusion: a prospective study. J Korean Med Sci. 2016;31:2020–5. https://doi.org/10.3346/jkms.2016.31.12.2020.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Erwood MS, Walters BC, Connolly TM, Gordon AS, Carroll WR, Agee BS, Carn BR, Hadley MN. Voice and swallowing outcomes following reoperative anterior cervical discectomy and fusion with a 2-team surgical approach. J Neurosurg Spine. 2018;28:140–8. https://doi.org/10.3171/2017.5.SPINE161104.

    Article  PubMed  Google Scholar 

  32. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016;71:706–17. https://doi.org/10.1111/anae.13438.

    Article  CAS  PubMed  Google Scholar 

  33. Liu J, Hai Y, Kang N, Chen X, Zhang Y. Risk factors and preventative measures of early and persistent dysphagia after anterior cervical spine surgery: a systematic review. Eur Spine J. 2018;27:1209–18. https://doi.org/10.1007/s00586-017-5311-4.

    Article  PubMed  Google Scholar 

  34. Liu FY, Yang DL, Huang WZ, Huo LS, Ma L, Wang H, Yang SD, Ding WY. Risk factors for dysphagia after anterior cervical spine surgery: a meta-analysis. Medicine (Baltim). 2017;96:e6267. https://doi.org/10.1097/MD.0000000000006267.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thanked Dr. Yen-Bin Hsu, Department of Otorhinolaryngology: Head and Neck Surgery, Taipei Veterans General Hospital for his critical comments on this manuscript.

Funding

This study was funded by the Anesthesiology Research and Development Foundation, Taiwan (ARDF10901), granted to Y.C. Chu, Department of Anesthesiology, Taipei Veterans General Hospital.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wen-Cheng Huang & Chi-Jen Chou

  2. National Research Institute of Chinese Medicine, Ministry of Health and Welfare, and Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan

    Elise Chia-Hui Tan

  3. Department of Pharmacology and Institute of Medicine, Chung Shan Medical University, and Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan

    Shiang-Suo Huang

  4. Department of Anesthesiology, Taipei Veterans General Hospital and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wen-Kuei Chang & Ya-Chun Chu

Authors
  1. Wen-Cheng Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elise Chia-Hui Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiang-Suo Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chi-Jen Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wen-Kuei Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ya-Chun Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ya-Chun Chu.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

(XLSX 41 kb)

Appendix: Bazaz Dysphagia Score

Appendix: Bazaz Dysphagia Score

Severity

Symptoms

Liquid

Solid

None

None

None

Mild

None

Rare

Moderate

None or rare

Occasionally (only with specific food)

Severe

None or rare

Frequent (majority of solids)

  1. Adapted from Bazaz et al. [1]

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, WC., Tan, E.CH., Huang, SS. et al. Postoperative Sore Throat Helps Predict Swallowing Disturbance on Postoperative Day 30 of Anterior Cervical Spine Surgery: A Secondary Exploratory Analysis of a Randomized Clinical Trial of Tracheal Intubation Modes. Dysphagia 37, 37–47 (2022). https://doi.org/10.1007/s00455-021-10247-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-021-10247-x

Keywords

Search

Navigation