Clinical Study Of The Effect Of Swallowing Function After ROI-C Anterior Cervical Interbody Fusion

Objectives: The difference of swallowing between a new zero- incisure anterior cervical interbody fusion device(ROI-C) and classical method with the plate using in anterior cervical decompression and fusion(ACDF) were discussed and analyzed with the potential risk factors stimulating the postoperative dysphagia, finding out an optimal method and providing a reference for clinical selection.Methods: 57 cases, the First Affiliated Hospital of Jinan University from Feb, 2013 to Mar, 2016, undergoing AC DF were retrospectively reviewed. There were 24 cases in group using with plate and 33 cases in group using with ROI-C. The difference of dysphagia incidence and severity were analyzed by comparing with the basic information(age, sex, postoperative hospital stay, operation time, blood loss, etc), image data(the measurement of thickness and index of prevertebral soft tissue(swelling or not), change of the cervical lordosis and swallowing videofluoroscopy) and grading or score(Bazaz-Yoo dysphagia grading, the Swallowing-Q uality of Life score) before and after operation. The correlative risk factors of dysphagia were obtained by C hi-square and logistic regression test, as well.Results: The dysphagia correlative risk factors analyzed by Chi-square and logistic regression test were internal fixation(with front plate), surgical level(high) and thickness of prevertebral soft tissue after 3d. When the PST(after 3d) was larger than 10.44 mm, the chance of developing postoperative was significantly greater. The operation time was(85.00±23.32)min in group ROI-C, was significantly lower than(130.13±29.13)min in group Plate(P <0.05). The blood loss was(43.13±12.56)m L in group ROI-C, was significantly lower than(104.55±93.23)m L in group Plate(P <0.05). The thickness of PST after 3d was(9.58±4.68)mm in group ROI-C, was significantly lower than(11.12±4.60)mm in group Plate(P <0.05). The dysphagia incidence after 3d was significantly lower in group ROI-C(9.1%) than that of group Plate(50.0%)(P <0.05). The thickness of PST of high level surgery after 3d was(11.08±4.09)mm in group ROI-C, waslower than(11.64±4.22)mm in group Plate, no significant difference was noted between two groups(P >0.05). The dysphagia incidence of high level surgery after 3d was lower but no significant in group ROI-C(6.1%) than that of group Plate(12.5%)(P >0.05). The thickness of PST of low level surgery after 3d was(8.26±4.54)mm in group ROI-C, was lower than(9.58±2.87)mm in group Plate, no significant difference was noted between two groups(P >0.05). The dysphagia incidence of low level surgery after 3d was lower but no significant in group ROI-C(0) than that of group Plate(8.3%)(P >0.05). Swallowing videofluoroscopy objectively found lower stimulation effect in group ROI-C than that of group Plate. The SWAL-QOL score after 3d of group ROI-C(60.50±6.20) was significantly higher than that of group Plate(53.84±6.96)(P <0.05).Conclusion: The dysphagia correlative risk factors were internal fixation(with front plate), high surgical level and thickness of prevertebral soft tissue after 3d. When the PST after 3d was larger than 10.44 mm, the chance of developing postoperative was significantly greater. Zero- incisure ROI-C anterior cervical interbody fusion device is associated with simpler surgical procedures, less operation time, less surgical trauma, wider applications, less stimulations to esophagus, lower postoperative dysphagia incidence, milder severity of dysphagia and shorter period of dysphagia in AC DF.