A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: the need for a paradigm shift

Sonja M. Molfenter, Milan R. Amin, Matina Balou, Erica G. Herzberg, Anthony Frempong-Boadu

Research output: Contribution to journalReview articlepeer-review


Objective: Dysphagia is the most commonly reported complication of annterior cervical discectomy and fusion (ACDF) surgery. However, the incidence of dysphagia post-ACDF varies widely–partly attributable to differing outcome measures used to capture dysphagia. Our objective was to conduct a scoping review of the literature to quantify which dysphagia outcome measures have been employed post-ACDF and examine trends by study design, year, and location. Methods: After removing duplicates, 2396 abstracts were screened for inclusion. A total of 480 studies were eligible for full-text review. After applying exclusion criteria, data was extracted from 280 studies. We extracted the dysphagia outcome measure(s), study design (prospective vs retrospective), year, and location (country). Approximately 10% of studies were repeated for intra-rater agreement. Results: In total, 317 dysphagia outcome measures were reported in 280 studies (primarily retrospective—63%). The largest proportion of outcome measures were categorized as “unvalidated patient-reported outcome measures” (46%), largely driven by use of the popular Bazaz scale. The next most common categories were “insufficient detail” and “validated patient-reported outcome measures” (both 16%) followed by “chart review/database” (13%) and instrumental assessment (7%). Studies examining dysphagia post-ACDF steadily increased over the years and the use of validated measures increased in the past 10 years. Conclusions: This scoping review of the literature highlights that nearly half of the ACDF dysphagia literature relies on unvalidated patient-reported outcome measures. The current understanding of the mechanism, timeline, and presentation of dysphagia post-ACDF are likely limited due to the metrics that are most commonly reported in the literature.

Original languageEnglish (US)
Pages (from-to)969-976
Number of pages8
JournalEuropean Spine Journal
Issue number3
StatePublished - Mar 2023


  • ACDF
  • Anterior cervical discectomy fusion
  • Dysphagia
  • Outcome measures
  • Scoping review
  • Swallowing

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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