Swallowing function after occipitocervical arthrodesis for cervical deformity in patients with rheumatoid arthritis

Ebata, Shigeto; Hatsushika, Kyousuke; Ohba, Tetsuro; Nitta, Kyohko; Akaike, Hiroshi; Masuyama, Keisuke; Haro, Hirotaka

doi:10.3233/nre-151262

Cited by 9 publications

(8 citation statements)

References 8 publications

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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%

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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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Section: Discussionmentioning

confidence: 99%

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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“…We believe that surgeons should pay more attention to the lower cranial nerve stretch airway obstruction caused by over-distraction of the occiputcervical vertical distance. Shigeto et al reported that the mechanism of dysphagia is not simply associated with the O-C2 angle, but that it also involves global craniocervical alignment in an individual patient, including the occiput-cervical distance [11]. Wang et al reported that performing OCF in the over-distraction position to treat vertical atlantoaxial dislocation may caudally displace the brainstem relative to the cranial base, resulting in traction injury to the 9th, 10th, and 11th lower cranial nerves [12].…”

Section: Discussionmentioning

confidence: 99%

A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance

Tang

Yang

Liao

et al. 2020

BMC Musculoskelet Disord

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Background: The aim of the present study was to describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects, as a proposed tool to guide restoration of vertical dislocations of the occipitocervical region in patients with basilar invaginations and for performing standardized testing of occipitocervical constructs. Methods: We analyzed neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) that were judged to be normal. The mean age of the included asymptomatic subjects was 48.0 ± 8.4 years old (range 20-69 years old; 48.4 ± 10.2 years old for males and 47.6 ± 6.4 years old for females). The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor's line. Occipitocervical distances (OCDs) were measured and analyzed its correlation with OC4Ds. Two spine surgeons each performed three measurements of the OC4D and OCD from each asymptomatic subject, from which our reported average values were derived. The height, weight, and body mass index (BMI) of each subject were recorded and analyzed for their correlations with the OC4D and OCD. Results: The OC4Ds from neutral, flexion, and extension lateral cervical spine radiographs were 69.0 ± 6.9, 68.9 ± 6.8, and 68.1 ± 6.9 mm, respectively. There was no significant difference in the OC4D values among neutral, flexion, and extension lateral cervical spine radiographs (P > 0.05). The neutral, flexion, and extension OCDs were 23.0 ± 4.8, 27.6 ± 6.0, and 13.8 ± 4.7 mm, respectively. In particular, the neutral OCD was significantly different from those in flexion and extension lateral cervical spine radiographs (P < 0.001). There was no significant correlation between OC4D and OCD in neutral, flexion, and extension (P > 0.05 for all). There were positive correlations between OC4D and height, as well as OC4D and weight, in neutral, flexion, and extension lateral cervical spine radiographs (P < 0.001 for all). Furthermore, the intra-class correlation coefficients for inter-and intra-observer reliabilities of OC4Ds in neutral, flexion, and extension lateral cervical spine radiographs were significantly higher than those for OCDs (P < 0.001).

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“…We believe that surgeons should pay attention to the lower cranial nerve stretch airway obstruction caused by overdistraction of the occiput-cervical vertical distance. Shigeto E et al reported that the mechanism of dysphagia is not simply associated with the O-C2 angle, but it also involves the global craniocervical alignment in an individual patient, including the occiput-cervical distance [10].Wang Q et al reported that performing OCF in the over-distraction position to treat vertical atlantoaxial dislocation may caudally displace the brainstem relative to the cranial base, resulting in traction injury to the 9 th , 10 th , and 11 th lower cranial nerves [11]. female patients), and the mean neutral OCD was 22.98 ± 5.10 mm (range, 9.88-38.64 mm).…”

Section: Discussionmentioning

confidence: 99%

A novel method for measurement of occipital-cervical distance by occiput-C4 distance

Tang¹,

Yang²,

Liao³

et al. 2019

Preprint

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Background: To describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects that can be used to guide the restoration of vertical dislocation of the occipitocervical region in patients with basilar invagination and to perform standardized testing of occipitocervical constructs.Methods: Neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) judged to be normal were analyzed. The mean age was 48.0±8.4 years old (range 20–69 years; 48.4±10.2 years old for males and 47.6±6.4 years old for females). Analysis consisted of measurement of the OC4D. The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor’s line. Two spine surgeons measured the OC4D thrice in the normal population and obtained the average values. Height, weight, and body mass index (BMI) of each subject was recorded and analyze its correlation with OC4D.Results: The values of OC4D on neutral, flexion, and extension lateral cervical spine radiographs were 69.0±6.9 mm, 68.9±6.8 mm and 68.1±6.9 mm, respectively. There was no significantly different from the values measured in neutral、flexion and extension (P> 0.05). But the OC4D of males were higher than females in neutral, flexion, and extension (P < 0.001 for all). There was a positive correlation between OC4D and height and weight in neutral、flexion and extension (P <0.001 for all). The correlation between O-C4D and BMI was weak, and no significant in neutral, flexion, and extension (P > 0.05). The ICC values of inter- and intra-observer agreements for the radiographic parameter in all of the cervical positions were more than 0.93.Conclusions: OC4D, a new measurement method for occipital-cervical distance that is not affected by the change in neutral, flexion, and extension positions, should be a valuable parameter and intra-operative tool to guide the vertical restoration during OCF for patients with altered occiput-cervical anatomy.

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Swallowing function after occipitocervical arthrodesis for cervical deformity in patients with rheumatoid arthritis

Cited by 9 publications

References 8 publications

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

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

A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance

A novel method for measurement of occipital-cervical distance by occiput-C4 distance

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