Supplementary Material for: Effects of Neuromuscular Electrical Stimulation on Chronic Dysphagia in a Single Subject After Anterior Cervical Discectomy and Fusion Surgery: A Case Report

Background: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy and fusion (ACDF) surgery. Case Presentation: An 83-year-old male experienced dysphagia >2 months post-ACDF. The patient presented with a narrowed pharyngoesophageal segment (PES) due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing on videofluoroscopic swallow study (VFSS). He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes. Reductions in penetration or aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient ended therapy after the post-treatment VFSS and began to experience odynophagia and submental pain. 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, these findings present 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.