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Systematic review.To determine the incidence and prevalence and identify effective recommendations to minimize the incidence and prevalence of postoperative dysphagia after anterior cervical surgery.The reported incidence and prevalence of postoperative dysphagia and risk factors associated with its development varies widely in the literature.A systematic review of the English-language literature was undertaken for articles published between January 1990 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining the incidence and prevalence of dysphagia after anterior cervical spine surgery. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria, assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.A total of 126 articles were initially screened, and 17 ultimately met the predetermined inclusion criteria. The rates of dysphagia found in the literature varied widely. Rates declined after surgery, but plateau at 1 year at a range of 13% to 21%. Risk factors identified were multilevel surgery and female sex. Specific preventive measures were not identified.A better understanding of dysphagia will require the development of better outcome measures.