Preoperative dysphonia and dysphagia improve following cervical deformity surgery

Abstract

BACKGROUND CONTEXT: Twenty-five percent of adult cervical deformity patients undergoing deformity correction have impairment due to a voice problem prior to surgery. Prior work has shown that these patients tend to be more frail and more likely to report preoperative dysphagia. We hypothesized that these patients could be at increased risk of post operative dysphonia and dysphagia. PURPOSE: The purpose of this study was to quantify how patients with preoperative dysphonia differ from their counterparts in terms postoperative dysphagia, dysphonia and HRQOL 6 weeks post surgery. STUDY DESIGN/SETTING: Retrospective analysis of a prospective multicenter cervical deformity database. PATIENT SAMPLE: Adult cervical deformity patients with preop dysphonia undergoing deformity correction. OUTCOME MEASURES: Voice handicap index-10 (VHI-10). METHODS: Retrospective analysis of a prospective multicenter cervical deformity database. The voice handicap index-10 (VHI-10) was used to assess patient's perception of impairment due to problems with their voice prior to surgery. A score ≥11 was considered indicative of dysphonia. Patients were divided into two groups: normalVHI group (VHI-10 score <11) and highVHI group (VHI score ≥11). The two groups were compared in terms of baseline demographics, alignment, surgical metrics, and 6-week dysphagia (measured on the EAT-10 questionnaire), and post operative outcomes. T-tests and chi2 tests were performed, as appropriate. The significance level was p<0.05. RESULTS: There were 74 ACD patients included: NormalVHI (n=58, average VHI score 2.77) and HighVHI (n=16, average VHI score 16.37). The groups were similar in terms of baseline demographics and preoperative alignment. There was no statistically significant difference in terms of surgical metrics between the two groups (revision surgery p=0.21, anterior approach p=0.92, use of osteotomies p=0.71, and OR time p=0.15). The two groups had a similar rate of in hospital adverse events (12.2% vs 7.7%, p=0.64), and similar improvements on the NDI, mJOA, and NRS neck and arm pain. HighVHI patients showed significant improvement on the VHI score 6 weeks post-surgery (11.18 vs 16.37, p=0.01). The HighVHI group also showed postoperative improvement on the EAT-10 questionnaire, compared to NormalVHI patients (-3.68 vs 4.03, p=0.003). CONCLUSIONS: Twenty-five percent of adult cervical deformity patients undergoing deformity correction have impairment due to a voice problem prior to surgery. Contrary to our initial hypothesis, these patients exhibited improvement in dysphonia and dysphagia scores 6 weeks post surgery, with 81% reporting improvement in symptoms of dysphonia, and 69% reporting improvement in symptoms of oropharyngeal dysphagia. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.