The Effect of an Esophageal Probe on Post Operative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion: A Randomized Prospective Study

Presented at SMISS Annual Forum 2014
By Mathew Cyriac MD
With Joseph OBrien MD, Daniel Huttman MD, Warren Yu MD,

Disclosures: Mathew Cyriac MD None Joseph OBrien MD B; Globus Medical, Medtronic, Stryker. D; K2M, RTI, ISD. F; Globus Medical, Nuvasive, RTI, Daniel Huttman MD None, Warren Yu MD None,

Introduction:
Dysphagia is a well-documented post-operative complication following ACDF (Anterior Cervical Discectomy and Fusion). This was a prospective, randomized controlled trial of patients undergoing primary ACDF. The control group had an esophageal temperature probe during surgery while the experimental group had no probe in the esophagus during surgery. The Swallowing-Quality of Life (SWAL-QOL) questionnaire was used to assess the degree and resolution of dysphagia over time in the two groups.

Aims/Objectives:
To determine whether an esophageal probe at the time of surgery plays a role in the development of post-operative dysphagia following primary ACDF.

Methods:
A total of 44 patients undergoing 1, 2, or 3-level ACDF were enrolled in the study and randomized into two groups, one containing esophageal probe at the time of surgery and one without. Each patient filled out the SWAL-QOL questionnaire at their pre-op visit and again at 2 weeks, 6 weeks, 3 months, 6 months and 1 year post-operatively to monitor dysphagia. The data was analyzed with respect to SWAL-QOL scores between groups and sub-analyzed based on number of levels and sex.

Results:
Placement of an esophageal temperature probe at the time of surgery led to significantly improved (p<0.05) dysphagia scores in patients undergoing 2-level ACDF compared to those without a probe at 2 weeks and 6 months post operative. Overall a trend towards improved dysphagia scores at each time point post-operatively was seen in the group with the probe. No differences were found between the two groups with respect to age, sex, operative time, number of levels fused, operative level, and pre-operative SWAL-QOL score.

Conclusions:
This pilot study shows the placement of an esophageal temperature probe at the time of surgery significantly improved post-operative dysphagia scores in patients undergoing 2-level ACDF. Further, the placement of an esophageal temperature probe was shown to decrease the severity of dysphagia following ACDF at each time point up to 1 year post-operatively. Post-hoc power analysis showed that a larger sample size was needed to detect the probe effect across all fusion levels.