Post-operative dysphagia following ventral cervical approach: complication or side-effect? Retrospective analysis and review of the literature

Abstract

Objective

To ameliorate the clinical decision-making process when debating between a ventral or dorsal cervical approach by elucidating whether post-operative dysphagia be regarded as a complication or a transient side effect.

Methods

A literature review of studies comparing complication rates following ventral and dorsal cervical approaches was performed. A stratified complication rate excluding dysphagia was calculated and discussed. A retrospective cohort of patients operated for degenerative cervical myelopathy in a single institution comprising 665 patients was utilized to analyze complication rates using a uniform definition for dysphagia.

Results

Both the ventral and the dorsal approach groups exhibited comparable neurological improvement rates. Since transient dysphagia was not considered a complication, the dorsal approach was associated with higher level of overall complications.

Conclusions and relevance

Inconsistencies in the definition of dysphagia following ventral cervical surgery impedes the interpretation of trials comparing dorsal and ventral complication rates. A uniform definition for complications and side effects may enhance the validity of medical trials.

Keywords:

• ACDF
• cervical spine surgery
• cervical discectomy
• ventral approach
• dorsal approach
• complications
• dysphagia

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Sheba institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval number: 0753-13-SMC. For this type of study, formal consent is not required.

Disclosure statement

Ran Harel is a consultant for Neurocord, Surgical theatre, Premia Spine and Mazor robotics, none of which are related to this paper, Nachshon Knoller, Nofar Michaeli, Mayan Nulman and Gil Kimchi have no conflict of interest.