Risk factors of dysphagia in patients with ossification of the anterior longitudinal ligament

Abstract

Introduction: Cervical ossification of the anterior longitudinal ligament (OALL) occasionally leads to dysphagia by the anterior osteophyte. A recent report explained that the dysphagia after an occipito-cervical fusion is caused by the narrowing of pharyngeal space due to the cranio-cervical malalignment. The purpose of this study was to evaluate the cranio-cervical alignment in patients with OALL complaining of the dysphagia. Subjects and methods: The subjects were 11 cases with complaining of dysphagia due to cervical OALL who underwent anterior cervical OALL resection and as control, age-matched 12 cases without dysphagia who have diffuse idiopathic skeletal hyperostosis in cervical spine. All subjects were male, and the mean age was 59.5 ± 9.1 years. The subjects were divided into two groups according to the symptoms of dysphagia (dysphagia, group A; control, group B). The O–C2 angle, C2–C7 angle, and the maximum thickness of OALL and the cranio-cervical alignment (pharyngeal inlet angle; PIA) and swallowing line (S-line) were measured before and after the operation on the lateral cervical radiogram at the sitting position. Results: Group A showed significantly large maximum thickness of OALL, small cervical range of motion, small O–C2 angle, large C2–C7 angle, and small PIA. The S-line crossed the anterior apex of cervical osteophyte in group A. After OALL resection, dysphagia had improved, PIA had increased, and the S-line uncrossed the apex of cervical vertebrae in all cases. Conclusion: The prevalence of dysphagia in patients with cervical OALL was influenced by the thickness of osteophyte, cervical mobility, and cranio-cervical alignment.

Research progress in the risk factors and screening assessment of dysphagia in the elderly

“…The prevalence of dysphagia is 27–64% in stroke patients, and approximately 50% in the acute phase ( 20 ). The figure is over 80% in patients with Parkinson’s disease ( 21 ) and 38% in those with multiple sclerosis ( 22 ).…”

“…While, it is 34.4% in those with head and neck cancer ( 23 ). The incidence of dysphagia in patients with ossification of the anterior longitudinal ligament (OALL) in the neck is influenced by the thickness of osteophytes, the range of cervical motion, and craniocervical alignment, and OALL occasionally leads to dysphagia due to the anterior osteophytes ( 20 ). Skeletal muscle loss is also thought to be a possible cause of dysphagia ( 21 ).…”

“…The incidence of dysphagia was reported to be 1–80% following anterior cervical surgery ( 20 , 24 ). Furthermore, Baron et al ( 25 – 27 ) found the incidence of transient dysphagia was up to 80% after anterior cervical fusion, and even higher in patients older than 60 years.…”

Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia—Molecular and Clinical Aspects

“…Present with solid foods, improved by neck flexion, and aggravated by neck straightening [48]. Incidence in patients with DISH is in the range of 0.2-28% [49].…”

“…Combined symptoms: foreign-body sensation, odynophagia, saliva stagnation, dysphonia, dyspnea [50]. Incidence of dysphagia in patients with cervical-spine DISH was influenced by osteophyte thickness, cervical-spine mobility, and craniocervical position [48].…”