This OrthoBuzz “Author 360”post is by Philip K. Louie, MD, Medical Director of Research and Academics at the Center for Neurosciences and Spine, Virginia Mason Franciscan Health in Seattle, Washington. Dr. Louie is a co-author of a new report in JBJS: Subjective and Functional Dysphagia After Anterior Cervical Spine Surgery. A Prospective Controlled Study.
If you perform anterior cervical spine surgery, dysphagia is one of the most common postoperative issues you discuss with patients. It’s also one of the most debated. Ask a group of spine surgeons how they think about postoperative dysphagia and you’ll likely hear a range of opinions from “expected and transient” to “a complication we should actively prevent.”
That wide range of opinions is exactly what motivated this study.
Like many surgeons, I frequently hear patients report a sensation of swallowing difficulty after surgery. The literature has long documented relatively high rates of postoperative dysphagia, but what has been less clear is how those symptoms translate into actual functional swallowing impairment. Are patients truly experiencing meaningful dysfunction that should be deemed a complication, or is this more just a collateral adverse event?
We designed this prospective study to explore that question more carefully by evaluating dysphagia from 2 different angles. Instead of relying solely on patient-reported symptoms, we paired subjective assessments (the Eating Assessment tool, or EAT-10) with a functional screening tool (the Yale Swallow Protocol). Our goal was to understand whether patients’ perceptions of dysphagia corresponded to objective swallowing deficits. Read the study.
One of the most striking observations was the disconnect between perception and function. Many patients reported dysphagia symptoms early after surgery, yet none demonstrated functional impairment on swallow testing. For clinicians, this raises an important question: should every report of postoperative dysphagia be framed as a complication, or might it represent part of the expected physiologic response to anterior cervical exposure?
Importantly, this work builds on decades of prior studies that have explored dysphagia after cervical spine surgery. Rather than replacing that literature, our goal was to add another dimension, which was combining subjective and objective evaluation within a prospective, controlled design.
Perhaps the biggest takeaway is that we still have more to learn. Dysphagia remains an important patient-centered outcome, and understanding how symptoms evolve over time will continue to inform how we counsel patients, design studies, and define surgical “complications.”
For now, this study invites us to reconsider how we frame a very common postoperative experience and reminds us that, sometimes, the most familiar problems still deserve a closer look.
Read the study at JBJS.org: Subjective and Functional Dysphagia After Anterior Cervical Spine Surgery. A Prospective Controlled Study
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