Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion

Wang, Lin-nan; Hu, Bowen; Song, Yueming; Liu, Limin; Zhou, Chunguang; Wang, Lei; Zhou, Zhongjie; Peng, Xiaoyan; Chen, Taiyong; Yang, Xi

doi:10.1016/j.spinee.2019.11.013

Cited by 13 publications

(18 citation statements)

References 23 publications

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“…Many potential risk factors have been reported, including age 1,2 , gender 3,4 , intraoperative esophagus traction 5,6 , long segmental surgery 7,8 , postoperative persistent pain 9,10 , prolonged procedure time 11 , high surgical position 12 , revision surgery 13 , esophageal intubation , and massive blood loss 15 . In addition, other risk factors were associated with dysphagia development such as thickness of internal plate 16 , intraoperative injury of esophagus 17 , postoperative cervical hematoma formation 18 , the use of BMP-2 19 , postoperative soft swelling 20 , scar formation and tissue adhesion 21 , internal compression of the esophagus 22 and recurrent laryngeal nerve injury [23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Tao

2020

Preprint

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Background. Dysphagia is a known complication of anterior cervical spine surgery and may be prolonged or occasionally serious. However, the association between posterior cervical spine surgery and the development of dysphagia is rare discussed. Furthermore, the risk factors of postoperative dysphagia are not well understood.Methods. Three hundred and fifty four patients were reviewed in this study, including 172 patients undergoing AC procedure, and 182 patients with PC procedure between June 2007 and May 2012. All patients were given the same postoperative management. The presence and severity of dysphagia were reported during the telephone interviews performed at 1, 3, 6, and 12 months after the procedure. The incidence and risk factors of dysphagia after cervical spine surgery were studied. Results. Of all 354 patients, 12.8% AC and 9.4% PC patients reported dysphagia at early postoperative assessment. The overall incidence for dysphagia at 1, 3, 6 and 12 months were decreased to 9.3%, 7.0%, 4.6% and 3.5% in AC group, and 6.0%, 4.4%, 2.2% and 1.6% in PC group, respectively. Long term use of Neck Collar after surgery may lead to postoperative dysphagia. Other risk factors such as age, gender, BMI, operative time, blood loss, procedure type, revision surgery and operative levels did not signiﬁcantly influence the incidence of postoperative dysphagia.Conclusions. Postoperative dysphagia is common after anterior and posterior cervical spine surgery. The incidence and severity of dysphagia both decrease over time. Long term use of neck collar after surgery is related of postoperative dysphagia. The neck collar should be worn no longer than four weeks after surgery. Age, gender, BMI, operative time, blood loss, procedure type, revision surgery and operative levels are not risk factors of postoperative dysphagia.

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Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Tao

2020

Preprint

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“…e O-C2 angle (the angle between McGregor's line and the inferior endplate of C2), S-line (the angle between McGregor's line and the line that links the center of the C1 anterior arch and the apex of cervical sagittal curvature), and O-EA angle (the angle between McGregor's line and the line joining the external auditory canal and the middle point of the caudal endplate of C2) have been reported to prevent postoperative dysphagia after occipitocervical (OC) fusion. [3,7,8] Our case did not include an OC lesion, and all postoperative parameters were within normal limits and/or comparable to preoperative angles. e video fluoroscopic evaluation showed pooling of contrast at the epiglottic vallecula and inflow into the Radcliff et al reported that PCF might result in dysphagia due to the loss of cervical motion.…”

Section: Discussionmentioning

confidence: 75%

Recurrent dysphagia after lower posterior cervical fusion

Ishikawa

Miyakoshi

Hongo

et al. 2020

Surgical Neurology International

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Background: Although dysphagia following posterior craniocervical fixation is well known, the incidence after mid-lower posterior cervical fixation is not well described. Here, we presented a case of recurrent dysphagia in a 72-year-old male following C3–T3 posterior cervical fixation and discussed its etiology. Case Description: A 72-year-old male sustained a cervical fracture in a fall; he was neurologically intact. The cervical/thoracic MR and CT studies documented ankylosing spondylitic changes in the cervicothoracic spine, a C5/6 disc herniation, and a C7 vertebral fracture. He underwent posterior cervical C3 to T3 fusion without decompression. For the 1st postoperative day, he complained of dysphagia without hoarseness, and fiberoptic endoscopy revealed poor esophageal mobility. For the next 6 postoperative years, he continued to require repeated attempts at the dilation of the esophageal entrance but remained reliant on a feeding tube. Conclusion: Posterior cervical fixation restricts cervical motion and may restrict expansion of the esophageal duct leading to permanent postoperative dysphagia requiring continued feeding tube utilization.

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“…In the present study, we reviewed the same batch of patients from April 2010 to June 2018 as in our previous study [4]. The inclusion criteria were as follows: (1) post-OCF patients; (2) a minimum follow-up of 12 months; and (3) complete preoperative and postoperative radiographic records.…”

Section: Methodsmentioning

confidence: 99%

“…Dysphagia is one of the most commonly seen complications after occipitocervical fusion (OCF), with an incidence ranging from 15.8-26.6% [1][2][3][4]. Most of these patients have a protracted course, and dysphagia interferes with the quality of daily living [3][4][5][6]. For this reason, the relationship between postoperative dysphagia and changes in occipitocervical alignment has been studied by many researchers, and several predictors have been promoted [1, 3-5, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

“…The newly promoted occipital and external acoustic meatus-to-axis angle (O-EAa) is the sum of the O-C2a and C2 tilting angles (C2Ta) and can reflect not only craniocervical junction alignment but also cranial transverse motion, thus compensating for the shortcomings of O-C2a [7]. In our previous study, we reviewed 109 OCF patients and found that O-EAa was superior to O-C2a in predicting decreases in oropharyngeal space and postoperative dysphagia [4]. However, during the measurement of O-EAa, we found it difficult to identify the external acoustic meatus in some patients.…”

Section: Introductionmentioning

confidence: 99%

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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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Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion

Cited by 13 publications

References 23 publications

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Incidence and Risk Factors of postoperative Dysphagia following Cervical Spine Surgery

Recurrent dysphagia after lower posterior cervical fusion

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

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