Objectives: The prevertebral fascia (PVF), which constitutes part of the deep layer of the deep cervical fascia, is routinely incised during anterior cervical discectomy and fusion (ACDF) surgery. Suturing the PVF could serve as an optimal barrier between the surface of the fusion device and the posterior esophagus and may alleviate postoperative dysphagia. Thus, this retrospective study was aimed to (1) evaluate the impact of prevertebral fascia (PVF) suturing and (2) perform a multivariate analysis of relevant risk factors for postoperative dysphagia following anterior cervical discectomy and fusion (ACDF).
Methods: A total of 197 patients who underwent ACDF and had at least 1 year of follow-up between June 2020 and February 2024 were retrospectively reviewed. To compare baseline data and incidence of dysphagia, the patients were divided into two groups on the basis of whether they had undergone PVF suturing during the operation (suture group, N = 83; nonsuture group, N = 114). The incidence and severity of dysphagia were evaluated using the Bazaz grading system. The patients were further categorized into a dysphagia group (N = 56) and a nondysphagia group (N = 141) to conduct a multivariate analysis of dysphagia.
Results: Compared with the nonsuture group, the suture group presented a significantly lower incidence and severity of dysphagia at 1 week, 1 month, and 3 months postoperatively (p < 0.05). A binary logistic regression analysis revealed that advanced age (odds ratio [OR], 1.034; 95% confidence interval [95% CI, 1.006–1.063]), greater ΔC2-7A (OR, 1.141; 95% CI, 1.056–1.232), minor ΔTS-CL (OR, 0.890; 95% CI, 0.842–0.941), and nonsutured PVF (OR, 0.329; 95% CI, 0.146–0.740) were significantly associated with higher rates of dysphagia (p < 0.05).
Conclusion: Suturing of the PVF during ACDF can significantly decrease the incidence and severity of transient postoperative dysphagia in patients. The incidence of postoperative dysphagia is also significantly associated with advanced age, greater ΔC2-7A, and minor ΔTS-CL.
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