Date of Defense

4-11-2024

Date of Graduation

4-2024

Department

Speech, Language and Hearing Science

First Advisor

Matthew Dumican

Second Advisor

Kathy Rigley

Abstract

Background: Current literature is lacking an understanding of the physiological mechanisms underlying dysphagia (impairment in swallowing function) that manifests as the result of anterior cervical discectomy and fusion (ACDF). ACDF is a common cervical spinal procedure that, due to its anterior to posterior (front-to-back) approach, risks significant injury to the larynx, which is critical for swallowing food and liquid safely. Furthermore, the general therapeutic approaches available to individuals with dysphagia after ACDF lack specificity of what is being targeted (Ko, et al. 2022). This project is a single subject case report of an individual who underwent ACDF and received neuromuscular electrical stimulation as their primary dysphagia treatment. The purpose of this study is two-fold: 1) to measure and describe the physiological characteristics underlying dysphagia in a patient with chronic, post-ACDF dysphagia, and 2) compare pre and post treatment swallowing function of a single male subject after undergoing dysphagia treatment using neuromuscular electrical stimulation (NMES).

Methods: The patient experienced dysphagia >2 months post-ACDF without physician referral for swallowing assessment. The patient sought an outpatient videofluoroscopic swallow study (VFSS) and presented with a narrowed pharyngoesophageal segment (PES) due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing. He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes and are presented.

Results: Reductions in penetration/aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient began to experience odynophagia and submental pain and ended therapy after the post-treatment VFSS. The patient experienced a complicated post-treatment course including bilateral cancerous masses at the base of tongue with subsequent surgery and chemoradiation.

Conclusions: While considered rare, this case presents a post-operative course of chronic dysphagia post-ACDF surgery where morphological changes to the pharynx significantly altered swallowing function. Swallowing function should be tracked routinely and longitudinally in post-ACDF surgery patients. NMES may be a potential dysphagia therapy modality to explore.

Access Setting

Honors Thesis-Open Access

Additional Files
Thesis Presentation.pdf (1921 kB)
Defense Presentation
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