Prospective Dysphagia and Dysphonia Assessment After the Simplified Retropharyngeal Approach for Anterior Cervical Surgery

BACKGROUND AND OBJECTIVES: Anterior access to the axial and upper subaxial cervical spine is anatomically constrained by the pharyngolaryngeal complex and adjacent neurovascular structures, and postoperative dysphagia/dysphonia remains clinically relevant after anterior approaches. The aim of this study was to prospectively quantify and explore predictors of patient-reported dysphagia and dysphonia after anterior cervical surgery performed through the Simplified Retropharyngeal (SR) approach. METHODS: This single-center prospective cohort included consecutive patients undergoing anterior cervical spine surgery through the SR 4-step approach (October 2019-July 2024). Outcomes were assessed with the Dysphagia Handicap Index (DHI), Dysphagia Outcome and Severity Scale (DOSS), and Voice Handicap Index (VHI), preoperatively and postoperatively at different time points. Predictors of dysphagia at 7 days and dysphonia within 24 hours were explored using multivariable Firth penalized logistic regression. RESULTS: Twenty patients (16 men, 4 women; mean age 59.5 years) were included; 45% were current smokers, and 75% had myelopathy. The mean operative time was 102 minutes. No intraoperative complications occurred. Postoperatively (≤24 hours), DHI >0 was reported by 90% (mean 10.1), DOSS was 7 (normal) in 80% and 6 (normal diet with modified independence) in 20%, and VHI >0 was reported by 50% (mean 7.7/120; range 1-20); in all patients, DHI and VHI returned to normal value by 180 days, and DOSS normalized within 7 days. No baseline covariate was significantly associated with DHI >0 at 7 days or VHI >0 at 24 hours. CONCLUSION: The SR approach was associated with frequent but transient patient-reported swallowing and voice symptoms, attributable to postoperative discomfort rather than true dysphagia, with complete recovery by the last follow-up. No functional impairment was detected on DOSS assessment. Larger controlled studies incorporating instrumental functional assessments are needed.