Swallowing and Speech Dysfunction in Patients Undergoing Anterior Cervical Discectomy and Fusion: A Prospective, Objective Preoperative and Postoperative Assessment *Anthony Frempong-Boadu, *John K. Houten, *Brett Osborn, †Jose Opulencia, †Latimer Kells, †Deborah D. Guida, and *Peter D. Le Roux Departments of *Neurosurgery and †Radiology, New York University School of Medicine, New York, New York, U.S.A. Summary: Swallowing difficulties and dysphonia may occur in patients undergoing anterior cervical discectomy and fusion. The etiology and incidence of these abnormali- ties, however, are not well defined. In view of this, we performed a prospective, objective analysis of swallowing function and vocal cord approximation in patients undergoing anterior cervical discectomy and fusion. Twenty-three consecutive patients (22 male and one female, mean age 59 years) undergoing anterior cervical discectomy and fusion had standardized modified barium swallow study and videolaryngoendoscopy performed preoperatively and again at 1 week and 1 month postoperatively. Eleven patients (48%) had radiographic evidence of preoperative swallowing abnormalities. The majority of these patients had myelopathic rather than radicular findings (p  0.03). None, however, had symptoms of swallowing dysfunction. Among these patients, one had worse function postoperatively, three had improvement, and function remained unchanged in seven. The preoperative swallowing assessment was normal in 12 patients (52%). Postoperative radiographic swallowing abnormalities were demonstrated in eight of these patients (67%). Preoperative vocal cord movement was normal in all patients. Postoperatively, vocal cord paresis was detected in two patients. The paresis was transient in one and permanent in the other. Age, previous medical history, operation duration, and spinal level decompressed were not significantly associated with the incidence of swallowing dysfunction. There was, however, a tendency for patients undergoing multilevel surgery to demonstrate an increased incidence of swallowing abnormalities on postoperative radiographic studies. In addition, soft tissue swelling was more frequent in patients whose swallowing function was worse postoperatively (p  0.007). Postoperative voice and swallowing dysfunction are common complications of anterior cervical discectomy and fusion, although in the majority of patients these abnormalities are not symptomatic. Patients undergoing multilevel procedures are at an increased risk for these complica- tions, in part because of soft tissue swelling in the neck. Key Words: Cervical spine surgery—Complications—Dysphagia—Prospective—Vocal cord paralysis. INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is fre- quently performed in the operative management of cervi- cal disc herniation and spondylosis. Although the proce- dure is associated with low morbidity, hoarseness and swallowing difficulties are common postoperative com- plaints (1–3). For example, Heeneman (4) observed post- operative voice change in 11% of patients, whereas Martin et al. (5) reported dysphagia significant enough to warrant referral for swallowing evaluation in 16.2% of patients. Mechanisms proposed for these complications include di- rect surgical trauma, neuropraxia from nerve traction, and Received July 19, 2001; accepted July 22, 2002. Address correspondence and reprint requests to Dr. Anthony Frempong-Boadu, Department of Neurosurgery, New York University Medical Center, 550 First Avenue, New York, NY 10016, U.S.A. E- mail: AnthonyFrempong@med.nyu.edu Journal of Spinal Disorders & Techniques Vol. 15, No. 5, pp. 362–368 © 2002 Lippincott Williams & Wilkins, Inc., Philadelphia 362