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

Abstract

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.

Role of preoperative cervical alignment on postoperative dysphagia after occipitocervical fusion

“…Our previous study showed that dysphagia in patients treated with a halo-vest brace is caused by decreased O-C2 angle. [ 9 ]…”

Impact of dysphagia and its severity on long‐term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathies other than inclusion body myositis

“…It has been widely used in Japan to assess dysphagia from various background diseases. 22,[34][35][36][37] In a study of patients with dysphagia, primarily those with underlying cerebrovascular disease, the inter-rater and intra-rater reliability of the FILS was excellent. 22 F I G U R E 2 Survival of patients with dysphagia.…”

“…FILS is a simple and quantitative method to evaluate the severity of dysphagia based on the route of nutritional intake and the food form without using instrumental swallowing tests or questionnaires. It has been widely used in Japan to assess dysphagia from various background diseases 22,34–37 . In a study of patients with dysphagia, primarily those with underlying cerebrovascular disease, the inter‐rater and intra‐rater reliability of the FILS was excellent 22 …”

Cervicogenic dysphagia associated with cervical spondylosis

“…[ 16 ] The study revealed that patients with cervical kyphosis have a significantly dilated pharynx, elongated hypopharyngeal transit time, and worsened penetration–aspiration scores (the depth to which food passes in the airway). [ 16 ] Other retrospective studies[ 17 18 ] in patients treated with an external immobilization of the cervical spine (wearing a Halo-vest) showed significant association with the incidence of dysphagia, ranging from 32 to 66%. Miyagi et al .…”

“…Miyagi et al . [ 18 ] observed that both smaller occiput–C2 (Oc–C2) angle and longer cervical immobilization were associated with the severity of dysphagia. The inadequate extension at Oc–C2 angle may contribute to the impact on the oropharyngeal space and swallowing difficulties in patients with halo-vest immobilization as well as normal individuals.…”