Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

Yamagata, Toru; Naito, Kentaro; Yoshimura, Masaki; Ohata, Kenji; Takami, Toshihiro

doi:10.4103/jcvjs.jcvjs_57_17

Cited by 14 publications

(12 citation statements)

References 28 publications

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“…Cervical tissues are dissected and drawn during anterior cervical fixation, which may cause local hyperemia or edema of tissues that manifests as PVST swelling in lateral radiographs. Postoperative PVST swelling may further compress the anterior pharynx, esophagus, or trachea, resulting in complications including dysphagia and respiratory tract obstruction (18)(19)(20)(21)(22)(23)(24)(25). PVST swelling peaks at about day 3 after the operation and gradually alleviates as time went on.…”

Section: Resultsmentioning

confidence: 99%

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Dai¹,

Liu²,

Chen³

et al. 2022

Acta Orthop Belg

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Atlantoaxial segments have not been discussed in existing studies on prevertebral soft tissue (PVST) swelling after cervical operations. This study aimed to investigate the characteristics of PVST swelling after anterior cervical internal fixation at different segments. This retrospective study included patients who underwent transoral atlantoaxial reduction plate (TARP) internal fixation (Group I, n=73), C3/C4 anterior decompression and vertebral fixation (Group II, n=77), or C5/C6 anterior decompression and vertebral fixation (Group III, n=75) at our Hospital. The PVST thickness at C2, C3, and C4 segments was measured before and 3 days after the operation. Time of extubation, number of patients with postoperative re-intubation and dysphagia were collected. Results show that all patients had significant postoperative PVST thickening (all P<0.01). PVST thickening at C2, C3, and C4 was significantly greater in Group I than in Groups II and III (all P<0.01). PVST thickening at C2, C3, and C4 in Group I was 1.87 (14.12mm/7.54mm), 1.82 (12.90mm/7.07mm) and 1.71 (12.09mm/7.07mm) times of that in Group II, respectively. PVST thickening at C2, C3, and C4 in Group I was 2.66 (14.12mm/5.31mm), 1.50 (12.90mm/8.62mm) and 1.32 (12.09mm/9.18mm) times of that in Group III, respectively. The patients in Group I had significantly later postoperative extubation (Both P<0.01) than the patients in Groups II and III. None of the patients had postoperative re-intubation or dysphagia. We conclude that PVST swelling was greater in patients who underwent TARP internal fixation than in patients who underwent anterior C3/C4 or C5/C6 internal fixation. Hence, after TARP internal fixation, patients should be given proper respiratory tract management and monitoring.

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Section: Resultsmentioning

confidence: 99%

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Dai¹,

Liu²,

Chen³

et al. 2022

Acta Orthop Belg

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“…[4] Yamagata et al found that patients with C3 prevertebral soft tissue swollen at 2 or 3 days after surgery were 8.7 times more likely to have postoperative dysphagia. [18] Patients with C4 prevertebral soft tissue swelling at 2 or 3 days after surgery were 4.7 times more likely to have postoperative dysphagia. Yagi et al found that prevertebral soft tissue edema was related to severe dysphagia and odynophagia after anterior cervical discectomy and fusion.…”

Section: Discussionmentioning

confidence: 99%

The role of esophageal area for dysphagia after anterior cervical corpectomy fusion: Change trends and risk factors

Sang

Chen

2023

Medicine

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The objective of this study is to assess the change trends of perioperative esophageal area for anterior cervical corpectomy fusion (ACCF) and to analyze the risk factors of the area for postoperative dysphagia. We retrospectively analyzed 309 patients who underwent ACCF due to degenerative cervical diseases between November 2015 and September 2019 at our hospital. Patients were divided into 2 groups named the dysphagia group and the normal swallowing function group, according to the swallowing function after ACCF. The esophageal area was measured at T1 level using computed tomography axial plane images before and after surgery (1 week, 1 month, 8 months, and 12 months), in order to assess the change trends of esophageal area perioperatively and analyze risk factors of the area for dysphagia after ACCF. The area was highest at 1 week after surgery and would be decreased over time in both groups, which was recovered to the preoperative levels in 12 months after surgery. The incidence of dysphagia after ACCF was 41.1%. In the dysphagia group, 127 patients (mean age 59.299 years) had dysphagia after ACCF. In the normal-swallowing function group, 182 patients (mean age 59.8352 years) had normal swallowing function after ACCF. The preoperative esophageal area was larger in the dysphagia group than in the normal-swallowing function group. Preoperative esophageal area was correlated with postoperative dysphagia (odds ratio: 1.3457, 95% confidence interval: 1.106-1.637). When the esophageal area at preoperation was above 3.388 cm 2 , the risk of postoperative dysphagia was higher. The esophageal area was the biggest at 1 week postoperatively, significantly decreased over time and would be recovered to the normal size at 12 months after surgery. Preoperative esophageal area should be considered when evaluating the risk factor for dysphagia after ACCF.

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“…The present study determined that postoperative changes in radiographic swelling and air indices are not different following ACDF with or without anterior plating. Prevertebral soft tissue swelling (PSTS) has been previously reported to correlate with dysphagia after ACDF [35,36]. As postoperative swallowing function was similar for Plate and Cage patients, it is intuitive that swelling and air indices would also be similar between cohorts.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Function Following Anterior Cervical Discectomy and Fusion With and Without Anterior Plating: A SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment

et al. 2019

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ObjectiveAnterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. This study aims to quantify the effect of anterior plating on swallowing-quality of life (SWAL-QOL) scores and radiographic swelling assessments following a primary, single-level ACDF. MethodsPatients retrospectively reviewed. Patients grouped into those receiving a cage or anterior plate. SWAL-QOL scores were recorded preoperatively and 6 weeks and 12 weeks postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anterior-posterior diameter of each involved vertebral body. An air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. ResultsSixty-eight primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between Cage and Plate cohorts. Finally, no differences were observed in postoperative SWAL-QOL scores or swelling and air indices between groups. ConclusionThe results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable.

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Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

Cited by 14 publications

References 28 publications

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

Prevertebral soft tissue swelling after anterior cervical internal fixation at different segments: a retrospective study

The role of esophageal area for dysphagia after anterior cervical corpectomy fusion: Change trends and risk factors

Swallowing Function Following Anterior Cervical Discectomy and Fusion With and Without Anterior Plating: A SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment

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