54 - A Comparison of Patient Centered Outcome Measures to Evaluate Dysphagi...

#54 A Comparison of Patient Centered Outcome Measures to Evaluate Dysphagia and Dysphonia after Anterior Cervical Discectomy and Fusion (ACDF)

Value and Outcomes in Spine Surgery

Poster Presented by: A. Patel


A. Patel (1)
S. Bhatt (1)
J. Ahn (2)
J. Savage (3)
W. Hsu (4)
K. Singh (2)

(1) Northwestern University, Chicago, IL, United States
(2) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
(3) Cleveland Clinic Main Campus, Center for Spine Health, Cleveland, OH, United States
(4) Northwestern University, Orthopaedic Surgery, Chicago, IL, United States


Introduction: Dysphagia and dysphonia are common complications after anterior cervical spine surgery. Despite their clinical importance, studies on the treatment and/or prevention of these complications are limited by the lack of valid and reliable outcome measures. Two new patient-centered outcome measures - the Eating Assessment Tool (EAT-10) Voice Handicap Index (VHI-10) - have been shown to have excellent validity and reliability in the otolaryngology patient population. These instruments may be used to document the dysphagia or dysphonia severity and monitor treatment response in patients with swallowing and voice disorders after anterior cervical spine surgery.

Materials and Methods: Following internal IRB approval, patients undergoing 1 to 3-level ACDF were recruited from two tertiary spine centers. Each patient prospectively complete the eating assessment tool (EAT-10), the voice handicap index (VHI-10), and the Bazaz score questionnaire prior to surgery, 1 day, 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year post-operatively. Mean scores were compared through ANOVA and proportion of patients with clinically significant scores (EAT-10 ≥ 3 and VHI-10 > 11) among each follow-up time. Internal reliability of EAT-10 and VHI-10 was tested via Cronbach's α while Pearson's correlation testing was employed to assess the correlation of EAT-10 to the Bazaz score.

Results: A total of 100 patients were included in the study, from which 85 completed 6 month follow-up and 64 completed 1 year follow-up. Baseline mean NDI scores were 18.74 (+/- 8.66) and improved to 7.52 (+/- 7.27) at 6 months (p< 0.05) and 8.22 (+/- 7.65) at 12 months (p< 0.05). Baseline EQ-5D index scores were 0.59 (+/-0.23) and improved to 0.79 (+/-0.16) at 6 months (p< 0.05) and 0.75 (+/- 0.17) at 12 months (p< 0.05). EAT-10 (α=0.978) and VHI-10 (α=0.900) demonstrated excellent internal reliability, in addition to the EAT-10 showing significant correlation to Bazaz (r = 0.794) across all time points. Mean EAT-10 and VHI-10 scores were significantly highest at 1 day post-op (p < 0.05). While mean EAT-10 scores increased with severity of dysphagia as defined by the Bazaz score, 10 of 556 scores (1.8%) of patients that claimed “no dysphagia” or “mild dysphagia” by the Bazaz score had clinically significant dysphagia (EAT-10 ≥ 3).

Conclusions: The EAT-10 and the VHI-10 scores showed excellent internal reliability. In addition, the EAT-10 score was an accurate measure across mild to severe dysphagia, and captured significant dysphagia in patients that would have otherwise been missed using the Bazaz score. The EAT-10 and VHI-10 surveys can provide a better measure of postoperative dysphagia and dysphonia than current outcomes used in spine surgery.