Influence of Postoperative O-C2 Angle on the Development of Dysphagia After Occipitocervical Fusion Surgery: Results from a Retrospective Analysis and Prospective Validation

Wang, Xingwen; Chou, Dean; Jian, Fengzeng

doi:10.1016/j.wneu.2018.05.047

Cited by 18 publications

(33 citation statements)

References 22 publications

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“…In recent years, how to avoid postoperative dysphagia by adjusting the occipitocervical angle has been widely studied [4, 6-8, 10, 11]. O-C2a has been proven to have predictive ability for post-OCF dysphagia [1,9,10,18]. However, in Izeki et al's study, reduction of anterior atlantoaxial subluxation (AAS) caused a decrease in nPAS despite an increase in O-C2a because the atlas shifted posteriorly [11].…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion

Wang

Song

et al. 2021

BMC Musculoskelet Disord

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Background PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). Methods Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. Results Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA <90° in predicting dysphagia reached 88.5%. Conclusions PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia. Trial registration This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019.

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Section: Discussionmentioning

confidence: 99%

Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion

Wang

Song

et al. 2021

BMC Musculoskelet Disord

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“…On the other hand, C2-C6 angle did not differ significantly between groups. Previous studies in patients who had undergone cervical fusion involving the cranium showed that O-C2 angle was related to the incidence of dysphagia [7][8][9][10][11][12][13][14][15][16]. Since the halo-vest is most effective method of fixation for vertebrae of the upper cervical spine, halo-vest fixation may resemble cervical fusion with the cranium rather than that without the cranium.…”

Section: Discussionmentioning

confidence: 99%

“…In patients who have undergone cervical fusion, accumulating evidence suggests that cervical alignment provides a predictor of postoperative dysphagia [7][8][9][10][11][12][13][14][15][16][17][18]. With occipitocervical fusion, the decrease in O-C2 angle is a predictor of dysphagia after surgery [7][8][9][10][11][12][13][14][15][16]. The decrease in O-C2 angle shifts the mandible posteriorly with the tongue root, resulting in a reduction in the pharyngeal space.…”

Section: Introductionmentioning

confidence: 99%

Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation

Miyagi

Takahashi

Tsuchiya

et al. 2020

BMC Musculoskelet Disord

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Background: Dysphagia is one of the most serious complications in patients treated with a halo-vest brace. However, the cause of dysphagia development by halo-vest fixation is not yet clear. We therefore investigated the incidence of dysphagia and cervical alignment as well as clinical data from medical charts in patients treated with a halo-vest brace. Methods: We retrospectively reviewed clinical data from the medical charts of 49 patients who had undergone halo-vest fixation. Occipito (O)-C2 angle, C2-C6 angle, and pharyngeal inlet angle were assessed by lateral plain Xrays of the cervical spine. The impacts of these parameters on incidence and severity of dysphagia were analyzed. Results: Thirteen patients (32%) suffered from dysphagia during halo-vest fixation, and age and length of intensive care unit (ICU) stay were greater in the dysphagia group (p = 0.044 and 0.013, respectively) than in those who did not develop dysphagia. O-C2 angle was smaller in the dysphagia group (p = 0.016). After multivariate logistic analysis, body mass index, ICU stay, and O-C2 angle remained as independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative correlation between ICU stay and Food Intake Level Scale (FILS) (p = 0.026), and a positive correlation between O-C2 angle and FILS (p = 0.008). Conclusion: This study suggested that O-C2 angle is related to both incidence and severity of dysphagia due to halo-vest fixation.

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“…The dysphagia scale was evaluated as follows: normal refers to patients without any swallowing difficulties; mild refers to patients with rare, intermittent episodes of dysphagia; moderate refers to patients with some difficulty when swallowing some special food; and severe refers to patients with difficulty even swallowing liquid 18 .…”

Section: Methodsmentioning

confidence: 99%

3D‐Printed Screw‐Rod Auxiliary System for Unstable Atlas Fractures: A Retrospective Analysis

Deng

et al. 2021

Orthopaedic Surgery

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Objective To develop and validate the efficacy of a 3D‐printed screw‐rod auxiliary system for unstable atlas fractures. Methods This research is a retrospective analysis, and a total of 14 patients, including 11 males and three females, were enrolled in our hospital from January 2017 to March 2019 who underwent occipitocervical fusion assisted by the 3D‐printed screw‐rod auxiliary system were reviewed, and with an average age of 53.21 ± 14.81 years, an average body mass index (BMI) of 23.61 ± 1.93 kg/m2. The operation time, blood loss and radiation times during the operation were recorded. The maximum fracture displacement values of pre‐ and post‐operation were measured based on CT imaging. All screw grades were evaluated after surgery. The occipital‐cervical 2 (O‐C2) angle and occipitocervical inclination (OCI) angle of pre‐operation, post‐operation and the last following‐up were measured. The dysphagia scale 3 months after surgery and at the last follow‐up, the Neck Disability Index (NDI) 3 months after surgery and at the last follow‐up were assessed. Results All patients were completed the surgery successfully. There was no patient with severe dysphagia or aggravation of nerve injury. The follow‐up was from 12 to 14 months, and with an average of 12.5 months. The average surgery time, average blood loss and average radiation times for the 14 patients were 112.14 min, 171.43 mL and 5.07 times, respectively. There was a significant difference in maximum fracture displacement between pre‐ and post‐operation values (P < 0.05). A total of 56 screws were inserted in 14 patients, among them, three screws were classified as grade 1, and the other screws were classified as grade 0. There was a significant difference in the O‐C2 between pre‐operation and 3 days after operation (P = 0.002); There was a significant difference in OCI angles between pre‐operation and 3 days after operation (P < 0.05); there was no significant difference in the O‐C2 or OCI angle between 3 days after the operation and the last follow‐up (P = 0.079; P = 0.201). The dysphagia scales of two patients were assessed as mild at 3 months after surgery, and the others were assessed as normal at 3 months after surgery. All patients' dysphagia scores returned to normal at the last follow‐up. The average NDI and average neck Visual Analogue Scale (VAS) scores at the last follow‐up were 2.53 and 8.41, respectively. Conclusion It can objectively restore the OCI to normal with few post‐operative complications under the assistance of a screw‐rod auxiliary system to perform occipitocervical fusion for unstable atlas fractures and atlantooccipital joint instability.

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Influence of Postoperative O-C2 Angle on the Development of Dysphagia After Occipitocervical Fusion Surgery: Results from a Retrospective Analysis and Prospective Validation

Cited by 18 publications

References 22 publications

Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion

Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion

Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation

3D‐Printed Screw‐Rod Auxiliary System for Unstable Atlas Fractures: A Retrospective Analysis

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