How Common is Dysphagia After Anterior Cervical Spine Surgery, What Drives it, and Can it be Prevented? An Umbrella Review of Systematic Evidence

Study DesignUmbrella systematic review.ObjectiveTo critically appraise and synthesise the existing systematic review evidence regarding incidence, risk factors, management strategies, and prognostic impact of dysphagia in patients undergoing anterior cervical spine surgery(ACSS), with interpretation explicitly weighted by methodological confidence.MethodsA systematic search (inception-November 2025) of PubMed, Embase, Scopus, Web of Science, and the Cochrane Database identified systematic reviews and meta-analyses evaluating dysphagia after ACDF, ACCF, CDA, or multilevel ACSS. Two reviewers independently screened and extracted data. Methodological quality was appraised using AMSTAR-2. Findings were synthesised narratively at the umbrella level and interpreted proportionate to the confidence of evidence.ResultsThirty-two systematic reviews (>3.6 million patients) were included. Dysphagia incidence ranged from 1%-79% (variations largely driven by heterogeneous definitions and timepoints). Early postoperative (≤2 weeks) dysphagia was common (up to 71%); whereas persistent dysphagia (≥12 months) was reported in 12-14% in selected analyses. Female sex, multilevel procedures, C3-C4 involvement, anterior plating, and rhBMP-2 exposure were recurrently associated with increased risk. In contrast, zero-profile implants, cuff-pressure control, and perioperative steroids were associated with reduced early dysphagia in low-confidence reviews. However, 31/32 reviews were rated critically low confidence by AMSTAR-2 grading, limiting certainty. Only one RCT-based steroid meta-analysis achieved low confidence.ConclusionDysphagia is frequently reported following ACSS, particularly in the early postoperative period. No preventive or therapeutic strategy can currently be recommended as standard of care based on high-certainty evidence. Most findings remain hypothesis-generating and require validation in high-quality prospective studies.