Effect of Anterior Cervical Osteophyte in Poststroke Dysphagia: A Case-Control Study

Objective: To investigate whether the concomitant presence of anterior cervical osteophytes can influence the severity and outcome of patients with poststroke dysphagia. Design: Retrospective case-control study. Setting: Hospital. Participants: A total of 40 participants were identified (N=40). Patients with poststroke dysphagia with anterior cervical osteophytes (n=20) were identified and matched by age, sex, location, and laterality of the stroke lesion to a poststrokg dysphagia control group with no anterior cervical osteophytes (n=20). Interventions: Not applicable. Main Outcome Measures: Videofluoroscopic swallowing study, Functional Oral Intake Scale (FOIS), and Penetration-Aspiration Scale results assessed within the first month of stroke were analyzed. The FOIS at 6 months was recorded, and severity of dysphagia was compared between the 2 groups. Results: The case group had larger degrees of postswallow residues in the valleculae and pyriform sinuses (P=.020 and P<001, respectively), with more patients showing postswallow aspiration (62.5%) than the control group (0%; P<.001), along with a higher risk of being on enteral nutrition feeding (odds ratio [OR] = 13.933; 95% confidence interval [CI], 2.863-infinity) within the first month of stroke. At the 6-month follow-up, the case group had significantly lower mean FOIS scores (3.8 +/- 1.7) than the control group (6.1 +/- 1.3; P<.001), with an increased risk of having persistent dysphagia (OR=15.375; 95% CI, 3.195-infinity). Conclusions: The presence of anterior cervical osteophytes, which may cause mechanical obstruction and interfere with residue clearance at the valleculae and pyriform sinuses and result in more postswallow aspiration, may influence initial severity and outcome of poststroke dysphagia. The presence of anterior cervical osteophytes may be considered an important clinical condition that may affect poststroke dysphagia rehabilitation. (C) 2015 by the American Congress of Rehabilitation Medicine