Jeffrey R. Carlson, MD
When I discuss cervical spine (neck) surgery with my patients, using the anterior (front of the neck) surgical approach, I am often asked about the effects of surgery on swallowing. In anterior cervical spine surgery (ACDS), I move the trachea (windpipe) and esophagus (eating tube) from their normal resting place to create access to the bones and discs of the neck for surgery. This can be done very safely and efficiently, allowing for an excellent view of the spine. However, moving the esophagus, specifically, may cause some throat soreness, scratchiness or the feeling that something is stuck in the throat, termed dysphagia. These symptoms are all normal aftereffects of moving the esophagus and typically resolve in the first few weeks after surgery.
The Hospital for Special Surgery in New York (Spine, April 2019), just published a study to determine which cervical surgery patients were more at risk for significant issues with swallowing. If there is severe swelling around or in the esophagus, a patient may not be able to swallow at all. Obviously, this presents a significant problem for patients in maintaining their hydration, feeding themselves and swallowing their pain pills. If there is further swelling, breathing may also be compromised.
The Hospital for Special Surgery studied the swallowing in patients that underwent the smallest anterior cervical surgery: a single-level disc surgery. They followed several different surgeons who used differing surgical implants, which gave them a good look at the variables that may affect post-operative swallowing. After following these patients for 6 months, they found that a shorter surgical time caused less problems with swallowing for patients after surgery. The type of implant didn’t matter, only the surgical time. Those patients with surgeries lasting less than 45 minutes had less difficulty with swallowing than those with longer surgery times. This makes some intuitive sense. The longer the surgery, the more pulling there is on the esophagus and the more swelling and irritation there will be when the surgery is done. There were a few patients that had problems with swallowing before surgery, and as expected, they had some problems with swallowing after surgery.
Surgery itself is stressful on the body, lengthy surgical times increase that stress. If you need cervical spine surgery, find a surgeon who is fellowship-trained in spine surgery AND who excels in surgical time management to prevent increased post-surgical swallowing difficulties. When I employ minimally-invasive surgical techniques during spine surgeries, my expectation is to get my patients back to their normal activities more quickly by improving their recovery experience. No one, including your surgeon, wants swallowing problems to hinder your post-surgical recuperation. (Or the post-surgical consumption of your favorite flavor of ice cream!)