{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:01Z","timestamp":1794324181560,"version":"4.9.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,9]]},"abstract":"\n Object<\/jats:title>\n This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history\/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and\/or fiberoptic endoscopic evaluation of swallowing\/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2\u20137 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput\u2013C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No other significant difference between the dysphagia and no-dysphagia groups was identified; differences with respect to history of previous anterior cervical surgery (p = 0.141), use of an anterior plate (p = 0.613), and mean length of anterior cervical operative time (p = 0.541) were not significant.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The incidence of dysphagia following combined anterior-posterior cervical surgery in this study was comparable to that of previous reports. The risk factors for dysphagia that were identified in this study were increased number of anterior levels exposed, anterior surgery that extended above C-4, and increased surgical correction of C2\u20137 lordosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.6.spine121134","type":"journal-article","created":{"date-parts":[[2013,7,12]],"date-time":"2013-07-12T09:53:00Z","timestamp":1373622780000},"page":"279-287","source":"Crossref","is-referenced-by-count":33,"title":["Dysphagia following combined anterior-posterior cervical spine surgeries"],"prefix":"10.3171","volume":"19","author":[{"given":"Ching-Jen","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwight","family":"Saulle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine121134","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1007\/s00586-006-0291-9","article-title":"Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion","volume":"16","author":"Aryan","year":"2007"},{"key":"b2-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","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"},{"key":"b3-spine121134","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/S0090-3019(97)00306-6","article-title":"Anterior cervical fusion using Caspar plating: analysis of results and review of the literature","volume":"49","author":"Bose","year":"1998"},{"key":"b4-spine121134","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/j.wneu.2010.05.034","article-title":"Early complications related to approach in cervical spine surgery: single-center prospective study","volume":"74","author":"Campbell","year":"2010"},{"key":"b5-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1097\/BRS.0b013e318158dec8","article-title":"Role of plate thickness as a cause of dysphagia after anterior cervical fusion","volume":"32","author":"Chin","year":"2007"},{"key":"b6-spine121134","series-title":"J Neurosurg Anesthesiol","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1097\/ANA.0b013e3182622843","article-title":"Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy","volume":"24","author":"Danto","year":"2012"},{"key":"b7-spine121134","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"425","DOI":"10.3171\/2012.1.SPINE11467","article-title":"Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. Clinical article","volume":"16","author":"Fehlings","year":"2012"},{"key":"b8-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2887","DOI":"10.1097\/BRS.0b013e318190affe","article-title":"Perioperative complications of combined anterior and posterior cervical decompression and fusion crossing the cervico-thoracic junction","volume":"33","author":"Hart","year":"2008"},{"key":"b9-spine121134","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.wneu.2011.07.004","article-title":"Dysphagia after anterior cervical spine surgery: incidence and risk factors","volume":"77","author":"Kalb","year":"2012"},{"key":"b10-spine121134","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.jocn.2011.02.033","article-title":"Multi-level spinal fusion and postoperative prevertebral thickness increase the risk of dysphagia after anterior cervical spine surgery","volume":"18","author":"Kang","year":"2011"},{"issue":"6 Suppl","key":"b11-spine121134","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"299S","DOI":"10.1016\/j.spinee.2006.04.025","article-title":"Indications for circumferential surgery for cervical spondylotic myelopathy","volume":"6","author":"Kim","year":"2006"},{"key":"b12-spine121134","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","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"},{"key":"b13-spine121134","series-title":"Spine J","doi-asserted-by":"publisher","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"},{"key":"b14-spine121134","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/jns.1980.53.1.0001","article-title":"Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases","volume":"53","author":"Lunsford","year":"1980"},{"key":"b15-spine121134","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.2106\/00004623-199512000-00001","article-title":"One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up","volume":"77","author":"McAfee","year":"1995"},{"key":"b16-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1097\/BRS.0b013e31818ff64e","article-title":"O-C2 angle as a predictor of dyspnea and\/or dysphagia after occipitocervical fusion","volume":"34","author":"Miyata","year":"2009"},{"key":"b17-spine121134","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"515","DOI":"10.3171\/SPI.2008.10.08226","article-title":"Circumferential fusion for cervical kyphotic deformity. Clinical article","volume":"9","author":"Mummaneni","year":"2008"},{"key":"b18-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E720","DOI":"10.1097\/BRS.0b013e3181f9f714","article-title":"Impact of the O-C2 angle on the oropharyngeal space in normal patients","volume":"36","author":"Ota","year":"2011"},{"key":"b19-spine121134","series-title":"J Anat","first-page":"245","article-title":"A study of weight transmission through the cervical and upper thoracic regions of the vertebral column in man","volume":"148","author":"Pal","year":"1986"},{"key":"b20-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/00007632-198805000-00001","article-title":"The vertical stability of the cervical spine","volume":"13","author":"Pal","year":"1988"},{"key":"b21-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1097\/01.brs.0000261627.04944.cf","article-title":"The impact of esophagus retraction on early dysphagia after anterior cervical surgery: does a correlation exist?","volume":"32","author":"Papavero","year":"2007"},{"key":"b22-spine121134","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1007\/s11999-010-1731-8","article-title":"What is the incidence and severity of dysphagia after anterior cervical surgery?","volume":"469","author":"Rihn","year":"2011"},{"key":"b23-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1097\/01.brs.0000186317.86379.02","article-title":"Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study","volume":"30","author":"Riley","year":"2005"},{"issue":"9 Suppl","key":"b24-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S76","DOI":"10.1097\/BRS.0b013e3181d81a96","article-title":"Postoperative dysphagia in anterior cervical spine surgery","volume":"35","author":"Riley","year":"2010"},{"key":"b25-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/00007632-200301150-00009","article-title":"Early reconstruction failures after multilevel cervical corpectomy","volume":"28","author":"Sasso","year":"2003"},{"issue":"2 Suppl","key":"b26-spine121134","series-title":"J Neurosurg","first-page":"214","article-title":"Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders","volume":"93","author":"Schultz","year":"2000"},{"key":"b27-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1097\/01.brs.0000201424.27509.72","article-title":"Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion","volume":"31","author":"Shields","year":"2006"},{"key":"b28-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1097\/01.BRS.0000129100.59913.EA","article-title":"Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures","volume":"29","author":"Smith-Hammond","year":"2004"},{"key":"b29-spine121134","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.1097\/01.brs.0000245863.52371.c2","article-title":"Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine","volume":"31","author":"Smucker","year":"2006"},{"key":"b30-spine121134","series-title":"J Bone Joint Surg Br","first-page":"1548","article-title":"Anterior fusion alone compared with combined anterior and posterior fusion for the treatment of degenerative cervical kyphosis","volume":"92","author":"Song","year":"2010"},{"key":"b31-spine121134","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"124","DOI":"10.3171\/SPI-07\/08\/124","article-title":"Dysphonia and dysphagia after anterior cervical decompression","volume":"7","author":"Tervonen","year":"2007"},{"key":"b32-spine121134","series-title":"Dysphagia","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"},{"key":"b33-spine121134","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00586-004-0849-3","article-title":"Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study","volume":"14","author":"Yue","year":"2005"},{"key":"b34-spine121134","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"523","DOI":"10.2106\/00004623-199704000-00007","article-title":"Failed anterior cervical discectomy and arthrodesis. Analysis and treatment of thirty-five patients","volume":"79","author":"Zdeblick","year":"1997"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/19\/3\/article-p279.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/19\/3\/article-p279.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/19\/3\/article-p279.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T19:12:44Z","timestamp":1681585964000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/19\/3\/article-p279.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,9]]},"references-count":34,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2013.6.spine121134","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2013,9]]}}}