Introduction: Dysphagia is a well-documented sequalae of cervical spinal cord injury (SCI). Additionally, the risk of dysphagia may increase following neurosurgical interventions. Persistent dysphagia may prompt the need for alternative means of enteral nutrition including nasogastric tube (NGT) placement or percutaneous endoscopic gastrostomy (PEG). The need for PEG following SCI has not been clearly demonstrated. The objective of our study is to explore key characteristics of patients with SCI that would warrant a PEG. Methods: A single institution, retrospective analysis was performed using trauma registry data from 2019 –2023. All adult patients with a diagnosis of cervical SCI were included. Exclusion criteria were as follows: pediatric patients, penetrating mechanism of injury or combined operative approach. Patients were divided into operative (OR) and non-operative (NO) management cohorts. The operative cohort was further divided by surgical approach (anterior approach, AA; posterior approach, PA). The primary outcome was frequency of PEG placement. Diagnosis of dysphagia was a secondary outcome. Descriptive and comparative analyses were performed using chi-square for categorical variables and ANOVA for continuous variables. Results: A total of 306 patients were included. The mean age was 55.84±17.8 with 72.9% being male. The median injury severity score (ISS) was 17IQR:9-75. Primary mechanisms of injury were fall (45.1%) and motor vehicle crash (41.2%). There were 98 patients in the NO cohort and 208 patients in the OR cohort (AA=80, PA=128). The NO cohort was older (58.8±18.4 vs 54.4±17.3, p=0.043) and had a lower body mass index (27.4±7.0 vs 29.4±7.8, p=0.045). Sex and ISS were not different between groups. There was no difference in dysphagia rate or frequency of PEG placement across all cohorts (p=0.75 and p=0.16, respectively). When stratifying patients by SCI level, there were no differences in NGT or PEG placement, tracheostomy, or diagnosis of dysphagia. Conclusions: Despite a third of patients having a diagnosis of dysphagia following cervical SCI, most do not require a PEG. Moreover, neither the frequency of dysphagia nor the need for PEG are influenced by level of injury, operative intervention, or operative approach.
Oh et al. (Sun,) studied this question.