Multifactorial Analysis of Postoperative Dysphagia and Functional Recovery Following Anterior Cervical Spine Surgery: A Multi-center Case Series

Background Anterior cervical discectomy and fusion (ACDF) is commonly performed for cervical degenerative conditions, but postoperative complications, specifically dysphagia, affect recovery and quality of life. While surgical developments helped minimize these risks, the effects of patient-related and intraoperative factors remain unclear. This study examines the impact of these factors on postoperative outcomes. Methods This study included 321 patients who underwent ACDF between 2022 and 2024 across four tertiary spine centers in Türkiye. Clinical assessment scores (EAT-10, NDI, VAS) were recorded preoperatively and at postoperative day 1, and months 1, 3, 6, and 12. Patients' smoking status and surgical details, including retractor type, retraction time, and duration of surgery, were collected. A propensity score-based inverse probability treatment weighting analysis was used to adjust baseline differences. Postoperative outcomes were analyzed using generalized estimating equations (GEE) in R (v4.4.3). Results The mean age was 46.6 ± 10.9 years; 170 were male. Smoking was reported in 162 patients (50.5%). Most surgeries were single-level (85.7%), predominantly at C5-6 (51.1%) and C6-7 (27.7%). The Özer retractor was used in 121 patients, while the Cloward-Caspar retractor was used in 200 patients. The GEE model showed prolonged retraction time was associated with higher NDI scores (β = +0.20, p < 0.001). Use of the Özer retractor was associated with higher NDI (β = +4.48) and lower VAS-arm scores. Smokers and females had worse scores. Conclusions ACDF is effective, with most patients improving early postoperatively. Patient and intraoperative factors influence recovery and should be addressed for optimal outcomes.