Dysphagia in older patients with degenerative cervical myelopathy: A longitudinal analysis following subaxial posterior cervical surgery

Purpose: To determine the prevalence and associated factors of dysphagia in older adults with degenerative cervical myelopathy (DCM), and to elucidate the longitudinal changes in swallowing function following subaxial posterior cervical spine surgery in this population. Methods: This retrospective study reviewed clinical records of patients aged ≥ 65 years who underwent surgical treatment for DCM at a single center. Swallowing function was assessed preoperatively and at 6 months and 1 year postoperatively using the Eating Assessment Tool-10. Patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). For longitudinal analysis, only patients who underwent subaxial posterior cervical surgery were included. Results: A total of 150 patients with DCM were analyzed. Preoperatively, 11.3% had dysphagia. The dysphagia group had a significantly smaller C7 slope and lower scores in the cervical spine function and quality of life domains of the JOACMEQ compared to the non-dysphagia group. Longitudinal analysis was conducted on 137 patients who underwent subaxial posterior cervical surgery. The prevalence of dysphagia increased from 9.5% preoperatively to 24.1% at 1 year postoperatively (p < 0.001). Patients with postoperative deterioration in swallowing function had higher body mass index and showed no significant improvement in any JOACMEQ domain, with some domains worsening postoperatively. Conclusion: Cervical sagittal imbalance may contribute to dysphagia in older patients with DCM. Postoperative dysphagia can develop even after subaxial posterior cervical surgery, particularly in older patients with limited improvement in cervical spine-related symptoms after surgery.