Long-term dysphagia after multilevel anterior decompressive surgery for cervical myelopathy: findings from the phase III CSM-Protect trial
Journal of Neurosurgery Spine · 7 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Dysphagia is the classic complication of anterior cervical spine surgery and a frequent exam topic, and this paper suggests it persists in nearly half of multilevel myelopathy patients at one year.
The evidence
This study re-analysed 132 adults from the CSM-Protect riluzole trial who had mostly multilevel (82.6% three or more levels) anterior cervical surgery for degenerative cervical myelopathy, tracking swallowing difficulty on the Bazaz scale for one year. In the Results, any dysphagia rose from 37.0% before surgery to 68.5% at 35 days and was still present in 45.5% at 365 days (6.0% severe). In a multivariable model, baseline dysphagia (OR 4.56), surgery involving C5 (OR 4.52) and shorter symptom duration (OR 0.98 per month) were associated with dysphagia at one year. The abstract reports lower one-year figures (36.4%) than the Results table.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Post-hoc / subgroup analysisDesign starting point: 32.2
Raised the score
- Prospectively registered+5.1
- 12-month follow-up+3.4
Lowered the score
- 56% loss to follow-up−8.5
- Underpowered−8.5
Methods at a glance
Recorded assessment- Confounding adjustmentNot applicable
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot applicable
- Adequate statistical powerUnderpowered
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 32.2
- 12-month follow-up
- +3.4
- 56% loss to follow-up
- −8.5
- Underpowered
- −8.5
- Prospectively registered
- +5.1
- Journal prior (not an observed method)
- +1
- Final rigour score rounded
- 25 / 100
Study design sets the starting point and a ceiling of 68. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should patients with preexisting swallowing complaints who need multilevel anterior surgery that includes C5 be counseled toward, or at least considered for, a posterior approach instead?
2.Which patients in your clinic warrant a formal preoperative swallow evaluation and planned postoperative speech-language follow-up after multilevel anterior cervical surgery?
Original publication title
Long-term dysphagia after multilevel anterior decompressive surgery for cervical myelopathy: findings from the phase III CSM-Protect trial