Association between Prevertebral Soft Tissue Thickening and Dysphagia in Cases of Traumatic Cervical Spinal Cord Injury

Abstract

The objectives of this study were to clarify whether prevertebral soft tissue (PVST) thickening increases the risk of dysphagia, to identify at which vertebral level determining PVST thickness is useful, and to determine cutoff values. Methods: A total of 80 patients with traumatic cervical spinal cord injury (TCSCI) treated over a 43-month period at a single regional institution specializing in cervical spinal cord injuries participated in the study. The exclusion criteria were having undergone anterior cervical spine surgery; a history of complicated traumatic brain injury, complicated vertebral artery injury, or brain injury; endotracheal intubation at day 30 after onset; the disappearance of neurological symptoms within 24 hours after onset; and the use of a halo vest. The associations between PVST thicknesses at C1, C2, C3, C6, and C7 measured by CT on the day of onset and the presence of dysphagia (Food Intake LEVEL Scale score <8) at 30 and 60 days after onset of TCSCI were analyzed using ROC curves to calculate the maximum area under the curve and the PVST cutoff values for these vertebrae. Associations between various risk factors, including PVST thickness, and dysphagia at days 30 and 60 after onset were examined using univariate and multivariate analyses. Results: Independent associations with dysphagia were found with the C3 PVST thickness (day 30: ≥8.3 mm, day 60: ≥9.4 mm) and tracheostomy. Conclusion: PVST thickness or injury seems to be an independent risk factor for dysphagia. By measuring PVST, it is possible to estimate the severity of dysphagia even in acute conditions.

Association between swallowing disorder and prevertebral hyperintensity on magnetic resonance imaging in patients after cervical cord injury without major fracture

“…Prevertebral soft tissue thickness (PVST) was measured using midsagittal sections on cervical CT (GE Healthcare, Waukesha, WI, USA) at C2, C3, and C6, as previously described. [ 9 ] The prevalence of high-intensity in the prevertebral space was evaluated using STIR midsagittal MR images (Exelart 1.5 T MRI System; Toshiba Co., Ltd., Tokyo, Japan). We assessed the prevertebral high-intensity area (HIA) and high-intensity anteroposterior width (HIW) at each vertebral level from C1 to C7 (Fig.…”

“…This has been pointed out by Mitsuishi et al in their discussion on the difficulty of setting the upper limit for PVST anterior to C4 and C5 owing to the characteristics of the soft tissue. [9] Magnetic resonance imaging (MRI) is useful for diagnosing and assessing discoligamentous cervical spine injuries in patients without skeletal injuries. In particular, prevertebral hyperintensity on T2-weighted MRI, which reflects prevertebral edema, fluid collection, or hemorrhage, is associated with initial cervical segmental instability in patients with CSCI without major bone injury.…”

“…Furthermore, swelling in the retropharyngeal space, evaluated using computed tomography (CT), has been reported as a possible risk factor for swallowing dysfunction. [ 6 , 9 ] This mechanism is believed to occur when the pharyngeal plexus and pharyngeal constrictor from part of the prevertebral soft tissue thickness (PVST) after sustaining damage. [ 6 ] Hayashi et al suggested that preventing swelling can be a considerable strategy for preventing or overcoming swallowing disorder.…”

“…This has been pointed out by Mitsuishi et al in their discussion on the difficulty of setting the upper limit for PVST anterior to C4 and C5 owing to the characteristics of the soft tissue. [ 9 ]…”

Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review

“…Numerous studies have demonstrated that the presence of a tracheostomy is a significant independent risk factor for dysphagia after cSCI [14,31,[72][73][74]. One study reported a threefold risk (RR: 3.67) of dysphagia with a tracheostomy following cSCI [73].…”