Modified Tracheal Traction Exercise Reduces the Incidence of Dysphagia in Patients with Multilevel Anterior Cervical Discectomy and Fusion

Abstract

Objectives: 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.

Methods: A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (n = 75) and traditional tracheal traction exercise (TTTE) (n = 68) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43 ± 11.25 years; TTTE: 52.35 ± 10.43 years), 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-JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia.

Results: Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, p = 0.018), reduced blood loss (102.03 ± 17.04 vs. 113.46 ± 14.92, p < 0.001), shorter surgical durations (159.04 ± 9.82 vs. 164.41 ± 12.22 min, p = 0.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c-JOA scores at 2 and 6 weeks favored MTTE, but no significant differences were observed at 12 and 24 weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of “normal” and lower incidences of “mild” and “moderate dysphagia” at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses.

Conclusion: Modified tracheal traction exercise demonstrates superior short-term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient-related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures.

Keywords

anterior cervical discectomy and fusion / complications / dysphagia / modified tracheal traction exercise / multilevel fusion

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.