{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:48:01Z","timestamp":1791938881679,"version":"4.3.4"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Dysphagia is a common early complication after anterior cervical spine surgery, yet its long-term natural history and risk factors remain incompletely understood, particularly in multilevel procedures for degenerative cervical myelopathy (DCM). This study aimed to characterize the natural history of postoperative dysphagia and identify predictors of persistent dysphagia at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Adult patients who received anterior decompression for DCM between 2012 and 2017 and were prospectively enrolled as part of the CSM-Protect trial were retrospectively reviewed. Presence and severity of dysphagia were assessed with the Bazaz scale (none, mild, moderate, or severe) at baseline and 35, 180, and 365 days postoperatively. Multivariable logistic regression controlling for study randomization and site were used to identify risk factors for dysphagia at 365 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From a total of 290 patients, 132 subjects met the eligibility criteria. Preoperatively, 11.4% of patients had moderate dysphagia. Dysphagia peaked at 35 days with 68.6% of all patients (14% severe) before declining to 47% at 180 days and 36.4% at 365 days. At 1 year, 10.6% had moderate dysphagia and 3.0% severe. Multivariable analysis demonstrated that anterior surgery at the C5 level (OR 4.52, 95% CI 1.16\u201319.4, p = 0.034), baseline dysphagia (OR 4.56, 95% CI 1.74\u201312.9, p = 0.003), and shorter duration of myelopathic symptoms (OR 0.98 per month, 95% CI 0.97\u20130.98, p = 0.027) were independently associated with persistent dysphagia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In this cohort of primarily multilevel anterior cervical surgical procedures, postoperative dysphagia peaked early but remained common at 1 year. Baseline dysphagia, C5-level involvement, and shorter symptom duration were key predictors of long-term dysphagia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.4.spine26260","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:01:30Z","timestamp":1791331290000},"page":"1-6","source":"Crossref","is-referenced-by-count":0,"title":["Long-term dysphagia after multilevel anterior decompressive surgery for cervical myelopathy: findings from the phase III CSM-Protect trial"],"prefix":"10.3171","author":[{"given":"Alex B.","family":"Bak","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlo M.","family":"Pedro","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto; and"},{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Moghaddamjou","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto; and"},{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto; and"},{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"J Craniomaxillofac Surg","first-page":"1363","article-title":"Severe postoperative dysphagia as an early predictor for decreased overall survival in patients with oral cancer","volume":"47","author":"Klingelh\u00f6ffer C","year":"2019","unstructured":"Klingelh\u00f6ffer C, Obst A, Ettl T,  Severe postoperative dysphagia as an early predictor for decreased overall survival in patients with oral cancer. J Craniomaxillofac Surg. 2019;47(9):1363\u20131369. doi:10.1016\/j.jcms.2019.06.011"},{"issue":"9 Suppl","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"S76","article-title":"Postoperative dysphagia in anterior cervical spine surgery","volume":"35","author":"Riley LH III","year":"2010","unstructured":"Riley LH III, Vaccaro AR, Dettori JR, Hashimoto R. Postoperative dysphagia in anterior cervical spine surgery. Spine (Phila Pa 1976). 2010;35(9 Suppl):S76-S85. doi:10.1097\/BRS.0b013e3181d81a96"},{"issue":"22","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"2453","article-title":"Incidence of dysphagia after anterior cervical spine surgery: a prospective study","volume":"27","author":"Bazaz R","year":"2002","unstructured":"Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):2453\u20132458. doi:10.1097\/00007632-200211150-00007"},{"issue":"2","key":"b4","series-title":"Spine J","first-page":"141","article-title":"Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study","volume":"7","author":"Lee MJ","year":"2007","unstructured":"Lee MJ, Bazaz R, Furey CG, Yoo J. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J. 2007;7(2):141\u2013147. doi:10.1016\/j.spinee.2006.02.024"},{"issue":"2 Suppl","key":"b5","series-title":"J Neurosurg","first-page":"176","article-title":"Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery","volume":"97","author":"Ratnaraj J","year":"2002","unstructured":"Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg. 2002;97(2 Suppl):176-179. doi:10.3171\/spi.2002.97.2.0176"},{"issue":"2","key":"b6","series-title":"Global Spine J","first-page":"571","article-title":"Evaluating dysphagia duration and severity after ACDF in patients with underlying dysphagia - a prospective, multicenter study","volume":"15","author":"Mazmudar A","year":"2025","unstructured":"Mazmudar A, Paziuk T, Tran KS,  Evaluating dysphagia duration and severity after ACDF in patients with underlying dysphagia - a prospective, multicenter study. Global Spine J. 2025;15(2):571\u2013579. doi:10.1177\/21925682231201249"},{"issue":"6","key":"b7","series-title":"Neurosurgery","first-page":"1287","article-title":"International and multicenter prospective controlled study of dysphagia after anterior cervical spine surgery","volume":"92","author":"Falavigna A","year":"2023","unstructured":"Falavigna A, Arruda AdO, Righesso Neto O,  International and multicenter prospective controlled study of dysphagia after anterior cervical spine surgery. Neurosurgery. 2023;92(6):1287\u20131296. doi:10.1227\/neu.0000000000002364"},{"issue":"7","key":"b8","series-title":"Bone Joint J","first-page":"868","article-title":"Dysphagia following anterior cervical spinal surgery: a systematic review","volume":"95-B","author":"Cho SK","year":"2013","unstructured":"Cho SK, Lu Y, Lee DH. Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J. 2013;95-B(7):868\u2013873. doi:10.1302\/0301-620X.95B7.31029"},{"issue":"1","key":"b9","series-title":"World Neurosurg","first-page":"183","article-title":"Dysphagia after anterior cervical spine surgery: incidence and risk factors","volume":"77","author":"Kalb S","year":"2012","unstructured":"Kalb S, Reis MT, Cowperthwaite MC,  Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg. 2012;77(1):183\u2013187. doi:10.1016\/j.wneu.2011.07.004"},{"issue":"5","key":"b10","series-title":"J Neurosurg Spine","first-page":"767","article-title":"Realistic long-term dysphagia rates after anterior cervical discectomy with fusion: is there a correlation with postoperative sagittal alignment and lordosis at a minimum 2-year follow-up?","volume":"37","author":"Xie R","year":"2022","unstructured":"Xie R, Liu J, Wang M, Dong Y, Mummaneni PV, Chou D. Realistic long-term dysphagia rates after anterior cervical discectomy with fusion: is there a correlation with postoperative sagittal alignment and lordosis at a minimum 2-year follow-up? J Neurosurg Spine. 2022;37(5):767\u2013775. doi:10.3171\/2022.4.SPINE211086"},{"issue":"12","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"859","article-title":"Predictors of dysphagia after anterior cervical discectomy and fusion: a prospective multicenter study","volume":"47","author":"Nguyen S","year":"2022","unstructured":"Nguyen S, Sherrod BA, Paziuk TM,  Predictors of dysphagia after anterior cervical discectomy and fusion: a prospective multicenter study. Spine (Phila Pa 1976). 2022;47(12):859\u2013864. doi:10.1097\/BRS.0000000000004279"},{"issue":"4","key":"b12","series-title":"Br J Neurosurg","first-page":"457","article-title":"Analysis of postoperative dysphagia after anterior cervical decompression and fusion","volume":"34","author":"Park JH","year":"2020","unstructured":"Park JH, Lee SH, Kim ES, Eoh W. Analysis of postoperative dysphagia after anterior cervical decompression and fusion. Br J Neurosurg. 2020;34(4):457\u2013462. doi:10.1080\/02688697.2020.1757037"},{"issue":"13","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"909","article-title":"Does operative level impact dysphagia severity after anterior cervical discectomy and fusion? A multicenter prospective analysis","volume":"49","author":"Paziuk T","year":"2024","unstructured":"Paziuk T, Mazmudar AS, Issa TZ,  Does operative level impact dysphagia severity after anterior cervical discectomy and fusion? A multicenter prospective analysis. Spine (Phila Pa 1976). 2024;49(13):909\u2013915. doi:10.1097\/BRS.0000000000004965"},{"issue":"14","key":"b14","series-title":"J Am Acad Orthop Surg","first-page":"627","article-title":"Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management","volume":"32","author":"Le HV","year":"2024","unstructured":"Le HV, Javidan Y, Khan SN, Klineberg EO. Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2024;32(14):627\u2013636. doi:10.5435\/JAAOS-D-23-00778"},{"issue":"6","key":"b15","series-title":"Eur Spine J","first-page":"1209","article-title":"Risk factors and preventative measures of early and persistent dysphagia after anterior cervical spine surgery: a systematic review","volume":"27","author":"Liu J","year":"2018","unstructured":"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(6):1209\u20131218. doi:10.1007\/s00586-017-5311-4"},{"issue":"4","key":"b16","series-title":"Spine J","first-page":"513","article-title":"Analysis of swallowing function after anterior\/posterior surgery for cervical degenerative disorders and factors related to the occurrence of postoperative dysphagia","volume":"23","author":"Yoshizawa A","year":"2023","unstructured":"Yoshizawa A, Nakagawa K, Yoshimi K,  Analysis of swallowing function after anterior\/posterior surgery for cervical degenerative disorders and factors related to the occurrence of postoperative dysphagia. Spine J. 2023;23(4):513\u2013522. doi:10.1016\/j.spinee.2022.12.010"},{"issue":"2","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"81","article-title":"Impact of frailty and cervical radiographic parameters on postoperative dysphagia following anterior cervical spine surgery","volume":"49","author":"Asada T","year":"2024","unstructured":"Asada T, Singh S, Maayan O,  Impact of frailty and cervical radiographic parameters on postoperative dysphagia following anterior cervical spine surgery. Spine (Phila Pa 1976). 2024;49(2):81\u201389. doi:10.1097\/BRS.0000000000004815"},{"issue":"22","key":"b18","series-title":"J Am Acad Orthop Surg","first-page":"848","article-title":"A comparison of patient-centered outcome measures to evaluate dysphagia and dysphonia after anterior cervical discectomy and fusion","volume":"27","author":"Rosenthal BD","year":"2019","unstructured":"Rosenthal BD, McCarthy MH, Bhatt S,  A comparison of patient-centered outcome measures to evaluate dysphagia and dysphonia after anterior cervical discectomy and fusion. J Am Acad Orthop Surg. 2019;27(22):848\u2013853. doi:10.5435\/JAAOS-D-17-00631"},{"issue":"2","key":"b19","series-title":"Dysphagia","first-page":"250","article-title":"Comparison of Bazaz scale, Dysphagia Short Questionnaire, and Hospital for Special Surgery-Dysphagia and Dysphonia Inventory for assessing dysphagia symptoms after anterior cervical spine surgery in Chinese population","volume":"37","author":"Liang G","year":"2022","unstructured":"Liang G, Zheng X, Liang C,  Comparison of Bazaz scale, Dysphagia Short Questionnaire, and Hospital for Special Surgery-Dysphagia and Dysphonia Inventory for assessing dysphagia symptoms after anterior cervical spine surgery in Chinese population. Dysphagia. 2022;37(2):250\u2013259. doi:10.1007\/s00455-021-10268-6"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26260\/article-10.3171-2026.4.SPINE26260.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26260\/article-10.3171-2026.4.SPINE26260.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:47Z","timestamp":1791936047000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26260\/article-10.3171-2026.4.SPINE26260.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":19,"URL":"https:\/\/doi.org\/10.3171\/2026.4.spine26260","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}