General Session: Diagnostic Imaging

Presented by: B. Khechen


B. Khechen(1), B. Haws(1), B. Mayo(1), D. Massel(1), J. Guntin(1), K. Cardinal(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States


Background information: The SWAL-QOL survey is a widely used, 13-section instrument to assess dysphagia and quality of life. In spine surgery, the SWAL-QOL is frequently used to assess changes in swallowing function following anterior cervical procedures. However, baseline SWAL-QOL variations by age have not been previously described.

Objective: To assess variations in SWAL-QOL scores across age groups.

Methods: A prospectively maintained database of patients who completed a SWAL-QOL survey prior to undergoing cervical spine surgery between 2014-2016 was reviewed. Patients were stratified by age into one of four cohorts: < 40 years, 40-49 years, 50-59 years, and ≥60 years. A scaled SWAL-QOL score was calculated by adding the total number of points scored for each section, and dividing by the total possible points for that section, as well as for the test as a whole. A secondary analysis was completed omitting question 9 and 13, as both assess general health not related to swallowing function.

Results: A total of 79 patients were included in this analysis, of which 11 (13.92%) were < 40 years old, 25 (31.65%) were 40-49, 31 (39.24%) were 50-59, and 12 (15.19%) were ≥60. The average scaled score for all patients was 92.2 ± 6.0, with a minimum score of 62.3 and a maximum of 100. Two patients (2.53%) achieved scores of 100, while 27 (34.18%) achieved scores over 95. No significant difference in total scaled SWAL-QOL score, or the scaled score for any individual section, was demonstrated across age cohorts. The secondary analysis demonstrated a mean score of 96.8 ± 5.3, with a minimum score of 68 and a maximum of 100. Twenty-four (34.18%) patients achieved scores of 100, while 63 (78.48%) achieved scores over 95. No significant difference in scores between age groups was demonstrated in the secondary analysis.

Conclusions: The results of this study suggest baseline dysphagia levels as assessed by SWAL-QOL in patients undergoing cervical spine surgery are not affected by patient age. As such, a preoperative scaled score of 92.2 may be considered normal for patients of all ages. Additionally, the total scaled score is significantly affected by questions 9 and 13 that assess general health and not swallowing. Thus, the SWAL-QOL may be adjusted to remove those questions in order to better assess pure swallowing ability and its effect on quality of life, with a scaled average of 96.8 across all age cohorts.

Table 1. Mean swallowing score by age group