Hyoid position as a novel predictive marker for postoperative dysphagia and dysphonia after anterior cervical discectomy
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ORIGINAL ARTICLE
Hyoid position as a novel predictive marker for postoperative dysphagia and dysphonia after anterior cervical discectomy and fusion Yushi Hoshino1,2,3 · Ichiro Okano1 · Erika Chiapparelli1 · Stephan N. Salzmann1 · Courtney Ortiz Miller1 · Jennifer Shue1 · Andrew A. Sama1 · Frank P. Cammisa1 · Federico P. Girardi1 · Alexander P. Hughes1 Received: 15 April 2020 / Revised: 18 May 2020 / Accepted: 27 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this study is to investigate the predictive value of the hyoid horizontal positional change on the severity of dysphagia and dysphonia (PDD) after anterior cervical discectomy and fusion (ACDF) comparing pre-vertebral soft-tissue thickness (PVST). Methods This is a retrospective observational study with prospectively collected data at a single academic institution. ACDF patients between 2015 to 2018 who had complete self-reported PDD surveys and pre- and postoperative lateral cervical radiographs were included in the analysis. PDD was assessed utilizing the Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI). The hyoid-vertebral distance (HVD) and PVST (the averages of C2 to C7 levels (PVSTC2–7) and all operating levels (PVSTOP)) were assessed preoperatively and upon discharge. The associations among postoperative changes of HVD, PVSTs, and the 4-week HSS-DDI score were evaluated. Results Of the 268 patients with a HSS-DDI score assessment, 209 patients had complete data. In univariate analyses, HVD and PVSTC2–7 changes demonstrated significant correlations with HSS-DDI, whereas PVSTOP showed no significant association. After adjusting with sex and operating level, the changes in HVD (p = 0.019) and PVSTC2–7 (p = 0.009) showed significant associations with the HSS-DDI score and PVSTOP showed no significant association. PVSTC2-7 could not be evaluated in 12% of patients due to measurement difficulties of PVST at lower levels. Conclusion We introduce a novel potential predictive marker for PDD after ACDF. Our results suggest that HVD can be utilized for the risk assessment of PDD, especially in PVST unmeasurable cases, which accounts for over 10% of ACDF patients. Keywords Hyoid · Anterior cervical discectomy and fusion · Dysphagia · Dysphonia · Hospital for special surgery dysphagia and dysphonia inventory
Introduction
Drs. Yushi Hoshino and Ichiro Okano contributed equally to this work. * Alexander P. Hughes [email protected] 1
Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
2
Department of Orthopaedic Surgery, Asahi University Hospital, 3‑23 Hashimoto‑cho, Gifu 500‑8523, Japan
3
Department of Orthopaedic Surgery, Showa University Koto Toyosu Hospital, 5‑1‑38 Toyosu, Koto‑ku, Tokyo 135‑8577, Japan
Anterior cervical discectomy and fusion (ACDF) is a common procedure performed for various cervical spine conditions, such as degenerative spondylosis, disc herniation, and fractures [1]. Compared to posterior procedures
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