{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:45:08Z","timestamp":1790876708978,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,7,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-term improvements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-term follow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.00325","type":"journal-article","created":{"date-parts":[[2017,7,4]],"date-time":"2017-07-04T13:00:01Z","timestamp":1499173201000},"page":"1069-1077","source":"Crossref","is-referenced-by-count":33,"title":["Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy"],"prefix":"10.2106","volume":"99","author":[{"given":"Narihito","family":"Nagoshi","sequence":"first","affiliation":[{"name":"Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Tetreault","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Arnold","sequence":"additional","affiliation":[{"name":"University of Kansas, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Barbagallo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Catania, Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branko","family":"Kopjar","sequence":"additional","affiliation":[{"name":"Department of Health Services, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"2","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3171\/2009.3.SPINE08724","article-title":"Anterior cervical surgery for the treatment of cervical degenerative myelopathy","volume":"11","author":"Matz","year":"2009","journal-title":"J Neurosurg Spine."},{"issue":"26","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1097\/BRS.0000000000000047","article-title":"Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients","volume":"38","author":"Fehlings","year":"2013","journal-title":"Spine (Phila Pa 1976)."},{"issue":"7","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.spinee.2013.07.474","article-title":"Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study","volume":"14","author":"Veeravagu","year":"2014","journal-title":"Spine J."},{"issue":"22","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1097\/00007632-200211150-00007","article-title":"Incidence of dysphagia after anterior cervical spine surgery: a prospective study","volume":"27","author":"Bazaz","year":"2002","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3171\/2013.6.SPINE121134","article-title":"Dysphagia following combined anterior-posterior cervical spine surgeries","volume":"19","author":"Chen","year":"2013","journal-title":"J Neurosurg Spine."},{"issue":"23","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1097\/BRS.0b013e318158dec8","article-title":"Role of plate thickness as a cause of dysphagia after anterior cervical 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assessment","volume":"15","author":"Frempong-Boadu","year":"2002","journal-title":"J Spinal Disord Tech."},{"issue":"8","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1007\/s00586-014-3281-3","article-title":"The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery","volume":"23","author":"Kang","year":"2014","journal-title":"Eur Spine J."},{"issue":"8","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.spinee.2012.03.024","article-title":"Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis","volume":"12","author":"Kepler","year":"2012","journal-title":"Spine J."},{"issue":"9","key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"E528","DOI":"10.1097\/BRS.0b013e31828a2992","article-title":"Postoperative prevertebral soft tissue swelling does not affect the development of chronic dysphagia following anterior cervical spine surgery","volume":"38","author":"Khaki","year":"2013","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/01.bsd.0000177211.44960.71","article-title":"Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study","volume":"18","author":"Lee","year":"2005","journal-title":"J Spinal Disord Tech."},{"issue":"2","key":"bib14-20230714","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.spinee.2006.02.024","article-title":"Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study","volume":"7","author":"Lee","year":"2007","journal-title":"Spine J."},{"issue":"2","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"256","DOI":"10.2106\/JBJS.G.00258","article-title":"Dysphagia following anterior cervical arthrodesis is associated with continuous, strong retraction 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Neurosurg."},{"issue":"17","key":"bib31-20230714","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1097\/BRS.0b013e31822340f2","article-title":"Dysphagia after anterior cervical spine surgery: a prospective study using the swallowing-quality of life questionnaire and analysis of patient comorbidities","volume":"36","author":"Siska","year":"2011","journal-title":"Spine (Phila Pa 1976)."},{"issue":"6","key":"bib32-20230714","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.spinee.2010.02.007","article-title":"Neck Disability Index, Short Form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion","volume":"10","author":"Carreon","year":"2010","journal-title":"Spine J."},{"issue":"6","key":"bib33-20230714","doi-asserted-by":"crossref","first-page":"e67408","DOI":"10.1371\/journal.pone.0067408","article-title":"Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference","volume":"8","author":"Auffinger","year":"2013","journal-title":"PLoS One."},{"issue":"21","key":"bib34-20230714","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1097\/BRS.0000000000001127","article-title":"The minimum clinically important difference of the modified Japanese Orthopaedic Association scale in patients with degenerative cervical myelopathy","volume":"40","author":"Tetreault","year":"2015","journal-title":"Spine (Phila Pa 1976)."},{"issue":"12","key":"bib35-20230714","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1007\/s00586-015-4208-3","article-title":"Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study","volume":"24","author":"Zhou","year":"2015","journal-title":"Eur Spine J."},{"issue":"22","key":"bib36-20230714","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1097\/00007632-200011150-00012","article-title":"On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery","volume":"25","author":"Apfelbaum","year":"2000","journal-title":"Spine (Phila Pa 1976)."},{"issue":"2","key":"bib37-20230714","first-page":"131","article-title":"The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery","volume":"28","author":"Tian","year":"2013","journal-title":"Dysphagia."},{"issue":"1","key":"bib38-20230714","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4055\/cios.2012.4.1.77","article-title":"Efficacy of postoperative radiograph for evaluating the prevertebral soft tissue swelling after anterior cervical discectomy and fusion","volume":"4","author":"Song","year":"2012","journal-title":"Clin Orthop Surg."}],"container-title":["Journal of Bone and 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