Aspiration and Reduced Cough Strength in Cervical Surgery Patients

John W. Kim, MD
Carol Smith Hammond, PhD (Durham, NC)
Don Bolder PhD (Gainesville, FL)
Delila Chilampath, BA,
Dennis Turner, MD (Durham, NC)

The reported subjective incidence of transient oropharyngeal dysphagia (OPD) after cervical spine procedures is as high as 80+ACU–. The risk of aspiration may be related to reduced cough strength. Subjects were male patients undergoing anterior (n+AD0–6) or posterior (n+AD0–5) cervical spine surgery. OPD was measured (pre– and postoperatively) using videofluoroscopic oropharyngeal swallow evaluation and the Dysphagia Disability Index (DDI). Voluntary cough strength was measured by oral/nasal airflow and sound pressure level (SPL).

Aspiration was observed postoperatively in patients undergoing either anterior or posterior procedures: 66+ACU– of anterior and 40+ACU– of posterior patients showed aspiration below the level of the true vocal cords. Silent aspiration (no reflexive cough) was observed in 4/6 of these patients. None of the tested patients showed preoperative aspiration. DDI scores (as a group) were significantly worse postoperatively (p less than .01) compared to preoperative exams. Patients that aspirated had lower peak expiratory flows (p less than .01) and SPL (p less than .001) during cough than control (no anesthesia, intubation, or surgery) subjects (n+AD0–6). Compared to preoperative exams there was significant postoperative aspiration in both anterior and posterior surgery groups. This suggests that anesthesia and intubation alone in cervical surgery patients enhances the risk of aspiration. In addition, there was a higher risk during anterior procedures presumably due to direct pharyngeal retraction or recurrent laryngeal nerve injury. The preoperative exams rarely identified patients at risk for postoperative aspiration. Cough strength measurements correlated with radiographically observed aspiration.