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Retrospective study.To analyze the reasons, clinical manifestation, risk factors, prevention, and treatment of dysphagia after operation of anterior cervical decompression and fusion (ACDF).Dysphagia is one of severe complications after ACDF. There were a few studies about reasons and prevention of dysphagia.We retrospectively reviewed medical charts of patients who underwent ACDF in our hospital from January 2012 to December 2012. Clinical symptom of dysphagia was recorded at the perioperative period and at the third and sixth month of the follow-up after surgery and assigned according to the Bazaz dysphagia score. We analyzed the reasons and risk factors leading to dysphagia and tried to find effective programs of prevention and treatment.There were 358 patients who underwent ACDF. Of 358 patients, 39 patients including 14 men and 25 women complained of dysphagia. The mean age was 46.8 years, with an age range of 38–67 years. Clinical manifestation of dysphagia included difficulty to swallow, pain during swallowing, sticky throat feeling, and choking. All the patients were followed up over 6 months. The incidences of dysphagia were 10.9%, 6.4%, and 2.7%, respectively, at 1–5 days, 3 months, and 6 months after surgery. There was no severe dysphagia at 3 months after surgery. Mild or moderate dysphagia slightly affected the quality of life. Logistic regression showed multilevel cervical spine, and high-level cervical spine surgeries are high-risk factors for postoperative dysphagia.Dysphagia is a common complication of ACDF. Causes of dysphagia include multilevel cervical spine and upper cervical spine surgeries. Use of methylprednisolone and careful operation can reduce the incidence and result in good prognosis.