Comparison of Patient-Reported Postoperative Dysphagia in Patients Undergoing One-Level Versus Two-Level Anterior Cervical Discectomy and Fusion with the Zero-P Implant System

To investigate whether dysphagia differs between one-level and two-level anterior cervical discectomy and fusion (ACDF) with the Zero Profile (Zero-P) Implant System. A retrospective analysis of 208 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up was performed from January 2013 to December 2018. The patients were divided into two groups based on the number of operated levels (one-level group, N = 86; two-level group, N = 122). Dysphagia was assessed based on the Bazaz grading system. The incidence of dysphagia and the severity of dysphagia at each follow-up were compared between the two groups. The patients were divided into two groups (nondysphagia group, N = 160; dysphagia group, N = 48), and covariates were obtained for multivariate analysis, including demographic parameters, surgical parameters, and radiographic parameters. The results showed that the incidence and severity of postoperative dysphagia in the two-level group were significantly greater at 1 week, 1 month and 3 months postoperatively than those in the one-level group. The results of ordinal logistic regression showed that older age, two-level surgery, greater prevertebral soft tissue swelling (PSTS) and the difference between the postoperative and preoperative C_2–7 angle (dC_2–7A) were significantly associated with a higher incidence of dysphagia after ACDF with the Zero-P. Two-level ACDF with the Zero-P can result in a significantly greater incidence and severity of transient postoperative dysphagia. Older age, greater PSTS and the dC_2-7A were also associated with postoperative dysphagia after ACDF with the Zero-P.