O-C2 Angle as a Predictor of Dyspnea and/or Dysphagia After Occipitocervical Fusion

Miyata, Masahiko; Neo, Masashi; Fujibayashi, Shunsuke; Ito, Hiromu; Takemoto, Mitsuru; Nakamura, Takashi

doi:10.1097/brs.0b013e31818ff64e

Cited by 131 publications

(129 citation statements)

References 10 publications

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“…However, a study by Miyata et al [32] demonstrated an association between negative changes in the O/C2 angle after posterior cervical fusion surgery in RA patients with symptoms of dyspnea, dysphagia, or both. In a separate study reviewed above, improvement in the O/C2 angle after occipito-cervical fusion surgery in RA patients was associated with symptomatic improvement in patients with concomitant sleep apnea.…”

Section: Discussionmentioning

confidence: 97%

Sleep apnea and cervical spine pathology

et al. 2013

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Purpose Sleep apnea is a multi-factorial disease with a variety of identified causes. With its close proximity to the upper airway, the cervical spine and its associated pathologies can produce sleep apnea symptoms in select populations. The aim of this article was to summarize the literature discussing how cervical spine pathologies may cause sleep apnea. Methods A search of the PubMed database for Englishlanguage literature concerning the cervical spine and its relationship with sleep apnea was conducted. Seventeen published papers were selected and reviewed. Results Single-lesion pathologies of the cervical spine causing sleep apnea include osteochondromas, osteophytes, and other rare pathologies. Multifocal lesions include rheumatoid arthritis of the cervical spine and endogenous cervical fusions. Furthermore, occipital-cervical misalignment pre-and post-cervical fusion surgery may predispose patients to sleep apnea. Conclusions Pathologies of the cervical spine present significant additional etiologies for producing obstructive sleep apnea in select patient populations. Knowledge of these entities and their pathophysiologic mechanisms is informative for the clinician in diagnosing and managing sleep apnea in certain populations.

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Section: Discussionmentioning

confidence: 97%

Sleep apnea and cervical spine pathology

et al. 2013

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“…The range of motion (ROM) for each angle was defined as: the angle at extension -the angle at flexion. The difference in ROM for each angle was defined as: postoperative ROMpreoperative ROM [17]. Radiographic measurements were performed independently by three spine surgeons using institutional digital radiography software (Centricity Enterprise Web ver.3.0; GE Yokogawa Medical Systems, Tokyo, Japan).…”

Section: Assessment Of Neurologic and Radiographic Characteristicsmentioning

confidence: 99%

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

et al. 2013

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Purpose A retro-odontoid pseudotumor is usually a reactive fibrocartilaginous mass associated with atlantoaxial subluxation (AAS). However, a retro-odontoid pseudotumor not associated with AAS, which undergoes spontaneous regression following C1 laminoplasty, has been reported. The purpose of this study was to report surgical outcomes of C1 laminectomy for retro-odontoid pseudotumor without AAS. Materials and methods The cases of seven patients (mean age 75.6 ± 7.6 years-old) with retro-odontoid pseudotumor without AAS were reviewed. The mean follow up time was 52.3 ± 25.5 months. Each patient underwent a C1 laminectomy with an additional C3-6 expansion laminoplasty in three patients. The Japanese Orthopaedic Association score (JOA score) was used for neurological assessment. Pseudotumor size and additional AAS were analyzed using MRI and radiography. Results All patients exhibited neurological improvement following surgery, the JOA score improved from 7.2 ± 3.2 to 14.1 ± 2.6. The mean O-C2 and C2-7 angle decreased from -3.2 ± 2.1°to -3.9 ± 1.7°, showing a slight kyphotic change. Postoperative AAS was not observed. All pseudotumors spontaneously resolved, and recurrence and regrowth were not observed. Five patients had MRIs after gadolinium administration; four patients who showed enhancement of the pseudotumor had almost complete reduction within 1 year following surgery.Discussion Our study, assessing the outcome of C1 laminectomy for retro-odontoid pseudotumor, found neurological improvement in all cases. Since all pseudotumors were reduced and additional AAS was not observed, C1 laminectomy for retro-odontoid pseudotumor, in the absence of AAS, is recommended as a therapeutic strategy.

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“…They found that a change in the O-C2 angle [ 10°is associated with narrowing of the oropharynx and postoperative dyspnea and dysphagia. 6 The measurements of our patient's O-C2 angle before and after halo fixation were 26.5°and 9.5°, respectively, for a reduction of 17°following application of the halo orthosis (Figs. 1a and 1b).…”

Section: Discussionmentioning

confidence: 72%

“…6 This is measured as the angle between McGregor's line (a straight line connecting the posterior edge of the hard palate to the most inferior tip of the occipital curve) and the line formed by the inferior endplate of the C2 vertebral body. Miyata et al compared changes in the O-C2 angle before and after occipitocervical fusion with an oropharyngeal cross-sectional area (measured from an axial view at the level of the tip of the epiglottis on a CT scan of the neck).…”

Section: Discussionmentioning

confidence: 99%

Cervical spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation: a case report

White

Wong

Goldstein

et al. 2014

Can J Anesth/J Can Anesth

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Purpose We present a case of upper airway obstruction in a patient with an unstable cervical spine fracture in a halo orthosis. We also describe the mechanism by which the obstruction occurred and identify features that predispose patients in a halo orthosis to upper airway obstruction. Case An 81-yr-old female presenting to hospital with an unstable cervical spine fracture was scheduled for spinal fusion. She was fitted with a halo traction device in a flexed position, and an awake tracheal intubation was planned. The patient's airway was topicalized and 1 mg of midazolam was administered. Her oxygen saturation dropped, and mask ventilation was difficult and insufficient. She then became unresponsive and pulseless.

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O-C2 Angle as a Predictor of Dyspnea and/or Dysphagia After Occipitocervical Fusion

Abstract: The O-C2 angle has considerable impact on dyspnea and/or dysphagia after O-C fusion. The O-C2 angle is easily measured during surgery and can be a practical index with which to avoid postoperative dyspnea and dysphagia.

Cited by 131 publications

References 10 publications

Sleep apnea and cervical spine pathology

Sleep apnea and cervical spine pathology

C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases

Cervical spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation: a case report

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