{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:55:54Z","timestamp":1787925354690,"version":"build-2784847793"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T00:00:00Z","timestamp":1721260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Dysphagia, an impairment in swallowing, is a frequent and debilitating complication for patients undergoing anterior cervical discectomy and fusion (ACDF), a common surgical treatment for degenerative cervical myelopathy (DCM). This retrospective study aimed to assess the efficacy of modified tracheal traction exercise (MTTE) in alleviating postoperative dysphagia and improving clinical outcomes for these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (<jats:italic>n<\/jats:italic>\u2009=\u200975) and traditional tracheal traction exercise (TTTE) (<jats:italic>n<\/jats:italic>\u2009=\u200968) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43\u2009\u00b1\u200911.25\u2009years; TTTE: 52.35\u2009\u00b1\u200910.43\u2009years), body mass index (BMI), comorbidities, fusion segments, and preoperative hospitalization days. Surgical duration differences were assessed. Clinical outcomes, dysphagia incidence, blood loss, postoperative complications, Cervical Japanese Orthopedic Association (c\u2010JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, <jats:italic>p<\/jats:italic>\u2009=\u20090.018), reduced blood loss (102.03\u2009\u00b1\u200917.04 vs. 113.46\u2009\u00b1\u200914.92, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), shorter surgical durations (159.04\u2009\u00b1\u20099.82 vs. 164.41\u2009\u00b1\u200912.22 min, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c\u2010JOA scores at 2 and 6\u2009weeks favored MTTE, but no significant differences were observed at 12 and 24\u2009weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of \u201cnormal\u201d and lower incidences of \u201cmild\u201d and \u201cmoderate dysphagia\u201d at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Modified tracheal traction exercise demonstrates superior short\u2010term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient\u2010related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14166","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T03:04:58Z","timestamp":1721358298000},"page":"2391-2400","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Modified Tracheal Traction Exercise Reduces the Incidence of Dysphagia in Patients with Multilevel Anterior Cervical Discectomy and Fusion"],"prefix":"10.1111","volume":"16","author":[{"given":"Jiasen","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Spinal Surgery Xinxiang Central Hospital  Xinxiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3407-0715","authenticated-orcid":false,"given":"Fudong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Shanghai Changzheng Hospital, Naval Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingchuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Shanghai Changzheng Hospital, Naval Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenjun","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Xinxiang Central Hospital  Xinxiang China"},{"name":"Department of Spinal Surgery The Fourth Clinical College of Xinxiang Medical University  Xinxiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Xinxiang Central Hospital  Xinxiang China"},{"name":"Department of Spinal Surgery The Fourth Clinical College of Xinxiang Medical University  Xinxiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangang","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Shanghai Changzheng Hospital, Naval Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0272-8383","authenticated-orcid":false,"given":"Kaiqiang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Shanghai Changzheng Hospital, Naval Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318154c57e"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199807000-00002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199173040-00011"},{"issue":"3","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173364","article-title":"The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: a prospective study","volume":"12","author":"Liu JM","year":"2017","journal-title":"PLoS One"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.03.030"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-30182-6"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2003.03.007"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000015767"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5311-4"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182477f26"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00258"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001172"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/21925682211046895"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-020-10197-w"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(04)90019-7"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2016(06)06"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jds.2018.11.002"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-022-01567-2"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23901"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000016941"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20150402-61"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.14166","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T06:48:29Z","timestamp":1728283709000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.14166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,18]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/os.14166"],"URL":"https:\/\/doi.org\/10.1111\/os.14166","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,18]]},"assertion":[{"value":"2024-05-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}