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Background This study examines the extent to which preoperative osteoporosis predicts dysphagia after cervical spine surgery. Osteoporosis has been associated with increased surgical risk and poorer outcomes in spine procedures, but its relationship with postoperative swallowing difficulties remains underexplored.
Methods A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized based on preoperative osteoporosis, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to assess the impact of preoperative osteoporosis on the incidence of dysphagia.
Results Of the 2,001 patients that met inclusion criteria, 110 (5.5%) reported preoperative osteoporosis. Patients experiencing preoperative osteoporosis demonstrated a higher incidence of dysphagia at baseline (29% vs. 15%, p<0.001), 1 month (69% vs. 55%, p=0.032), and 12 months follow up (38% vs. 25%, p=0.014) but not at 3 months follow up (30% vs. 29%, p=0.7). Additionally, patients with preoperative osteoporosis experienced significantly more severe dysphagia at baseline (3.864 ± 7.422 vs. 1.678 ± 4.875, p=<0.001), 1 month (8.516 ± 8.602 vs. 6.246 ± 7.682, p=0.032), and 12 months (4.338 ± 7.296 vs. 2.537 ± 5.061, p=0.014). Further stratification revealed that preoperative osteoporosis did not impact incidence of dysphasia in patients without baseline dysphasia at 1 month (p=0.2), 3 months (p>0.9), or 12 months (p=0.14). Multivariable analyses with baseline dysphagia as a fixed effect demonstrated that osteoporosis is not an independent predictor of postoperative dysphagia at 1 month (OR=1.58, p=0.2), 3 months (OR=0.61, p=0.095), or 12 months (OR=1.05, p=0.9). Exclusion of the patient subset with baseline dysphasia reflected similar results in post-hoc multivariable analyses.
Conclusion While patients with osteoporosis have higher rates of postoperative dysphagia at baseline, 1-month, and 12-month follow-up, preoperative osteoporosis did not independently predict dysphasia following cervical surgery. The increased rate of postoperative dysphagia in patients with preoperative osteoporosis may be attributed to comorbid conditions (coronary artery disease, chronic pulmonary disease, etc.) more prevalent in osteoporosis patients. Neurosurgeons may benefit from knowing this information to guide preoperative patient decision-making to undergo surgery in patients with osteoporosis.
