Impact of the occiput and external acoustic meatus to axis angle on dysphagia in patients suffering from anterior atlantoaxial subluxation after occipitocervical fusion

Chen, Taiyong; Yang, Xi; Kong, Weijun; Li, Zhongyang; Song, Yueming

doi:10.1016/j.spinee.2019.04.002

Cited by 9 publications

(20 citation statements)

References 25 publications

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“…The following causes may lead to oropharyngeal stenosis: anatomical abnormalities due to RA, postoperative hematoma, edema of the airway due to intubation, anterior decompression of anterior atlantoaxial subluxation, and improper fixation angle of the upper cervical vertebra [ 3 , 8 , 13 , 15 , 27 ]. Extensive investigations measuring cervical lateral radiographs before and after surgery found that oropharyngeal stenosis was closely related to the reduced occipitocervical angle after fixation, and some specific occipitocervical angles could be used as imaging indicators to predict postoperative dysphagia [ 3 , 10 , 11 , 16 ]. However, there are no clear clinical criteria about which parameter can be used effectively for predicting postoperative dysphagia, especially in patients with C2–3 KFS.…”

Section: Discussionmentioning

confidence: 99%

“…Some scholars have shown that patients’ complaints of dysphagia were self-reported [ 3 , 6 , 10 , 11 , 13 , 14 ]. Besides, past studies have discussed the possible underlying mechanism of dysphagia and dyspnea after OCF is mainly mechanical stenosis of the airway space [ 6 , 8 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Later, Morizane et al [ 16 ] proposed the occipital and external acoustic meatus to axis angle (O-EAa) to indicate craniocervical junction alignment, which could reflect the translation of the cranium in relation to C2 and may affect the narrowest oropharyngeal airway space (nPAS). Chen et al [ 10 ] suggested that maintaining a postoperative O-EAa value of 100° would reduce postoperative dysphagia. Therefore, maintenance of the O-C2a and O-EAa at an appropriate level is a practical and effective method to prevent postoperative dysphagia.…”

Section: Introductionmentioning

confidence: 99%

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The predictive ability of occipital to C3 angle for dysphagia after occipitocervical fusion in patients with combined C2–3 Klippel-Feil syndrome

Zou

Wang

Yang

et al. 2022

BMC Musculoskelet Disord

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Background Improper occipitocervical alignment after occipitocervical fusion (OCF) may lead to devastating complications, such as dysphagia and/or dyspnea. The occipital to C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa) have been used to evaluate occipitospinal alignment. However, it may be difficult to identify the inferior endplate of the C2 vertebra in patients with C2–3 Klippel-Feil syndrome (KFS). The purpose of this study aimed to compare four different parameters for predicting dysphagia after OCF in patients with C2–3 KFS. Methods There were 40 patients with C2–3 KFS undergoing OCF between 2010 and 2019. Radiographs of these patients were collected to measure the occipital to C3 angle (O-C3a), O-C2a, occipito-odontoid angle (O-Da), occipital to axial angle (Oc-Axa), and narrowest oropharyngeal airway space (nPAS). The presence of dysphagia was defined as the patient complaining of difficulty or excess endeavor to swallow. Patients were divided into two groups according to whether they had postoperative dysphagia. We evaluated the relationship between each of the angle parameters and nPAS and analyzed their influence to the postoperative dysphagia. Results The incidence of dysphagia after OCF was 25% in patients with C2–3 KFS. The Oc-Axa, and nPAS were smaller in the dysphagia group compared to non-dysphagia group at the final follow-up (p < 0.05). Receiver-operating characteristic (ROC) curves showed that dO-C3a had the highest accuracy as a predictor of the dysphagia with an area under the curve (AUC) of 0.868. The differences in O-C3a, O-C2a, O-Da, and Oc-Axa were all linearly correlated with nPAS scores preoperatively and at the final follow-up within C2–3 KFS patients, while there was a higher R2 value between the dO-C3a and dnPAS. Multiple linear regression analysis showed that the difference of O-C3a was the only significant predictor for dnPAS (β = 0.670, p < 0.001). Conclusions The change of O-C3a (dO-C3a) is the most reliable indicator for evaluating occipitocervical alignment and predicting postoperative dysphagia in C2–3 KFS patients. Moreover, dO-C3a should be more than − 2° during OCF to reduce the occurrence of postoperative dysphagia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The predictive ability of occipital to C3 angle for dysphagia after occipitocervical fusion in patients with combined C2–3 Klippel-Feil syndrome

Zou

Wang

Yang

et al. 2022

BMC Musculoskelet Disord

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“…They aimed to address the shortcomings of O-C2cobb, which showed a wide deviation and couldn't reflect the translational changes in the cranium in relation to C2 ( 21 , 22 ). The relationship between O-C2cobb/O-EAa and postoperative dysphagia has been discussed in several studies ( 20 – 23 ). Wang et al ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for postoperative dysphagia after C1-2 fusion

et al. 2022

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ObjectiveThis study aimed to analyze the risk factors for dysphagia after C1-2 fusion in patients with C1-2 junction diseases.Summary of the background dataDysphagia is a common postoperative complication of posterior C1-2 junction surgery. The incidence is 9.5% to 26.3%. However, the etiopathogenisis of postoperative dysphagia remains controversial.MethodsThis retrospective study included patients who underwent C1-2 fusion from January 2016 to January 2020. The patients were divided into dysphagia group and control group in accordance with the Bazaz R dysphagia scoring system. The patients' age, gender, BMI(body mass index), cause of disease, and changes in the C01cobb, C02cobb, C12cobb, C27cobb, dC02cobb, dC01cobb, dC12cobb, d C27cobb angles before and after operation, were recorded. The parameters and changes were compared to analyze the risk factors for dysphagia after C1-2 fusion.Results65 cases (15, with dysphagia; 50, without dysphagia) were included. The incidence of postoperative dysphagia was 23%. The differences in age, gender ratio, and BMI between the two groups were not significant (P > 0.05). The differences among postoperative C12 (29.8° ± 11.24° vs. 20.46° ± 13.39°), postoperative C27cobb (10.56° ± 8.53° vs. 20.21° ± 13.21°), and dC12cobb (9.49° ± 5.16° vs. 1.07° ± 12.44°) between the two groups were significant (P < 0.05). Multiple logistic regression analyses revealed that dC12cobb > 5° was a significant independent risk factor for postoperative dysphagia, And preoperative C27cobb was a preventive factor of postoperative dysphagia.ConclusionsDysphagia after the C1-2 fusion was common. dC02cobb and dC12cobb were the significant independent risk factors for postoperative dysphagia. Preoperative c27cobb was a preventive factor of dysphagia.

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“… 5 - 7 Despite careful preoperative planning, complications are relatively common from surgery and can often lead to debilitating or fatal consequences. 8 - 11 In many instances, the undesirable outcomes may be secondary to the unique anatomy of the occipitocervical junction posing substantial surgical challenges. In many instances, the occiput precludes easy access for instrumentation and provides limited space for the multiple fixation points required as part of appropriate surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans

Bernstein

Ikpeze

Foxx

et al. 2021

Global Spine Journal

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Study Design: Retrospective observational study. Objective: To establish occipital condyle dimensions (length, width, height), as well as the medialization angle necessary for safe occipital condyle screw placement in occipitocervical fixation. Methods: Between 1/2014-6/2014, patients who presented to a single level 1 academic trauma center emergency room and received computed tomography (CT) imaging of the cervical spine as part of routine clinical care were identified. After excluding patients with cervical fractures, neoplastic disease, or infection, 500 condyles representing 250 patients were analyzed. Condyle length, height, and width (all reported in millimeters [mm]) were evaluated on the sagittal, coronal, and axial series, respectively. Medialization angle (reported in degrees) was evaluated on the axial series of CT imaging. Measurements were compared by sex and age. Results: The average condyle length, width, and height were 18.6 millimeters (mm) (range, 14.5-23.0 mm), 10.5 mm (range, 7.4-13.8 mm), and 11.3 mm (7.1-15.3 mm), respectively. Additionally, the average occipital condyle medialization angle was 23° (range, 14-32°). Occipital condyles of men were significantly longer, wider, and taller (all comparisons, p < 0.05). The medialization angle was significantly steeper for women than men (p < 0.05). No measurement differences were appreciated by age. Conclusion: Our findings are similar to previous studies in the field; however, length appears slightly shorter. Further, measurement differences were appreciated by sex but not age. Thus, our measurement findings emphasize the importance of preoperative planning utilizing individual patient anatomy to ensure safe placement of occipital condyle screws for optimal outcomes.

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Impact of the occiput and external acoustic meatus to axis angle on dysphagia in patients suffering from anterior atlantoaxial subluxation after occipitocervical fusion

Cited by 9 publications

References 25 publications

The predictive ability of occipital to C3 angle for dysphagia after occipitocervical fusion in patients with combined C2–3 Klippel-Feil syndrome

The predictive ability of occipital to C3 angle for dysphagia after occipitocervical fusion in patients with combined C2–3 Klippel-Feil syndrome

Analysis of risk factors for postoperative dysphagia after C1-2 fusion

Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans

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