Clinical efficacy analysis of cervical pharyngeal plexus preservation measures in preventing dysphagia after long-segment anterior cervical discectomy and fusion

English Keywords:Anterior cervical discectomy and fusion surgery  Dysphagia  Pharyngeal plexus nerve protection

English Abstract:

  【Abstract】 Objectives: To explore the value of intraoperative pharyngeal plexus nerve protection in preventing dysphagia following long-segment anterior cervical discectomy and fusion(ACDF). Methods: A retrospective analysis was performed on 64 patients who underwent long-segment(3-4 levels) ACDF in Chengdu Office Hospital of the People′s Government of Xizang Autonomous Region from January 2018 to June 2024. 34 patients received intraoperative pharyngeal plexus nerve protection were assigned to the protection group, and the remaining 30 patients without such protection were included in the conventional group. There were no statistically significant intergroup differences in baseline data including gender, age and disease duration(P>0.05). Operation-related parameters such as number and distribution of operative levels, operative time and intraoperative blood loss were recorded. The neck disability index(NDI) and Japanese Orthopaedic Association(JOA) scores before surgery, at 3 months and 1 year postoperatively were documented to evaluate clinical outcomes. The SWAL-QOL questionnaire was administered preoperatively and at 3d, 3 months and 1 year after surgery. The Bazaz dysphagia grading system was used at 3d, 3 months and 1 year postoperatively to assess the incidence and severity of postoperative dysphagia. Computed tomography(CT) was conducted at the 1-year follow-up. Interbody fusion status was evaluated according to the Brantigan classification, and grades 1-3 were defined as non-fusion, and grades 4-5 as fusion. Results: No statistically significant differences were found between the two groups regarding the number and distribution of operative levels, operative time or intraoperative blood loss(P>0.05). NDI and JOA scores were significantly improved at 3 months and 1 year postoperatively compared with preoperative values in both groups(P<0.05). There were no intergroup differences preoperatively or at same postoperative follow-up time points(P>0.05). Preoperative SWAL-QOL scores were comparable between the two groups(P>0.05). In the protection group, SWAL-QOL scores decreased significantly at postoperative 3d(P<0.05), while scores at 3 months and 1 year showed no significant difference from baseline(P>0.05). In the conventional group, SWAL-QOL scores were markedly lower than preoperative levels at 3d, 3 months and 1 year postoperatively(P<0.05). At each corresponding follow-up time point, SWAL-QOL scores in the protection group were significantly lower than those in the conventional group(P<0.05). At 3d, 3 months and 1 year postoperatively, dysphagia occurred respectively in 2 cases, 0 case, and 0 case in the protection group, while the number was 8, 4, and 4 in the conventional group. The protection group demonstrated a lower dysphagia incidence at all follow-up time points(P<0.05). At the 1-year follow-up, successful interbody fusion was achieved in 31 patients of the protection group and 27 patients of the conventional group. No significant differences were observed in fusion rates(91.2% vs 90.0%) and Brantigan fusion grades between the two groups(P>0.05). Conclusions: Intraoperative pharyngeal plexus nerve protection measures can effectively reduce the incidence of dysphagia after long-segment ACDF.