Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: B. Mayo

Author(s):

B. Khechen(1), B. Haws(1), B. Mayo(1), D. Massel(1), D. Bohl(1), A. Narain(1), F. Hijji(1), J. Guntin(1), K. Cardinal(1), K. Singh(1)

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

Abstract

Object: The SWAL-QOL survey is an instrument that has been applied to patients undergoing ACSS procedures as a means of objectifying swallow function. However, the SWAL-QOL is long, cumbersome and primarily utilized for otolaryngological procedures. Thus, the object of the study was to identify the swallowing disorders (SWAL-QOL) questions most relevant to dysphagia following anterior cervical spine surgery (ACSS).

Methods: Patients undergoing ACDF procedures were administered the SWAL-QOL survey prior to surgery and at the 6- and 12-week postoperative visits. For each visit, a scaled SWAL-QOL score was calculated by adding the number of points scored and by dividing the total possible points. The average total scores, scores for each section, and scores for each question were compared between office visits using paired t-tests.

Results: Of the 78 eligible patients, 50 (64.1%) completed surveys at all three encounters and were included in the analysis. The total scaled score at 6 weeks was significantly lower than the preoperative score (p=0.003) but returned to near baseline scores by 12 weeks (p=0.178). Five sections had significantly lower scores at both postoperative visits compared to their respective preoperative values. An additional two sections had significantly lower scores only at the 6-week postoperative visit. Additionally, 13 individual questions had significantly lower scores at both postoperative visits, while 8 had significantly lower scores at only one of the postoperative visits. Of these 21 questions demonstrating statistical significance, 16 also demonstrated a clinically significant decrease (>5.0%) from preoperative scores. These 16 questions were included in the abridged survey developed for use in ACCS patients.

Conclusions: The results of this study suggest the full SWAL-QOL questionnaire may not be necessary to detect significant changes in swallowing function following an ACDF. Several sections and individual questions demonstrated minor or no changes at the postoperative visits. As a result, we propose a modified, 16-question SWAL-QOL survey including only the questions that were both statistically and clinically significant. This truncated survey may be better suited for use in cervical spine patients who typically present with less severe symptoms as compared to those with head and neck cancer, the population for which the SWAL-QOL was primarily designed.

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