Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review

Abstract

Background Occipitocervical fusion (OCF) is a procedure performed for multiple upper cervical pathologies. A common postprocedural complication of OCF is dysphagia, which has been linked to the narrowing of the pharyngeal space due to fixation in a hyper-flexed angle. Postoperative dysphagia is linked to reduced quality of life, prolonged hospital stay, aspiration pneumonia, and increased mortality. This has led to investigations of the association between sagittal radiographic angles and dysphagia following OCF. Methods A systematic review of the literature was performed to explore the current evidence regarding cervical sagittal radiographic measurements and dysphagia following OCF. A search strategy was carried out using the PubMed, Embase, and Web of Science databases from their dates of inception until August 2022. Only original English-language studies were considered. Moreover, studies had to include the correlation between dysphagia and at least one radiographic measurement in the sagittal plane. Results The search and subsequent selection process yielded eight studies that were included in the final review, totaling 329 patients in whom dysphagia had been assessed and graded. The dysphagia score by Bazaz et al. (Spine 27, 22:2453–2458, 2002) was used most often. The pooled incidence of dysphagia, in the early postoperative period, was estimated at 26.4%. At long-term follow-up (range: 17–72 months), about one-third of patients experienced resolution of symptoms, which resulted in a long-term post-OCF dysphagia incidence of 16.5%. Across the studies included, six different radiographic parameters were used to derive several measures which were repeatedly and significantly associated with the occurrence of dysphagia. Conclusions The high incidence of postoperative dysphagia following OCF warrants close monitoring of patients, especially in the short-term postoperative period. These patients may be assessed through standardized tools where the one by Bazaz et al. was the most commonly used. Moreover, there are several radiographic measurements that can be used to predict the occurrence of dysphagia. These findings may serve as a basis for strategies to prevent the occurrence of dysphagia after OCF.

Dysphagia, health-related quality of life, and return to work after occipitocervical fixation

“…Previous studies have reported 10–25% dysphagia after OCF at long-term follow-up, and our results are in line with these reports [ 28 ]. In this study, 53% of the individuals reported any dysphagia and 27% moderate to severe dysphagia.…”

“…Recently, it was shown that approximately 25% of patients undergoing OCF experienced dysphagia at short-term follow-up. However, at long-term follow-up (12–72 months), resolution of the swallowing difficulties was seen in one-third of these patients [ 28 ]. Efforts to predict and prevent postoperative dysphagia are crucial as this complication has been associated with prolonged hospital stay, reduced health-related quality of life (HRQoL) [ 25 ], and increased mortality [ 3 , 11 , 12 , 20 , 27 , 30 ].…”

“…Efforts to predict and prevent postoperative dysphagia are crucial as this complication has been associated with prolonged hospital stay, reduced health-related quality of life (HRQoL) [ 25 ], and increased mortality [ 3 , 11 , 12 , 20 , 27 , 30 ]. In a systematic review, several pre- and post-operative radiographic measurements were found to correlate with the occurrence of dysphagia in patients undergoing OCF [ 28 ] (Fig. 1 ).…”

Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients

“…27 Postoperative dysphagia after OC fusion occurred in 26% of patients, perhaps caused by hyperflexion or misalignment of the upper cervical spine during OC fusion, resulting in pharyngeal stenosis. 28,29 The LC1-PC2 fixation, which provides high biomechanical strength, has become the most popular treatment for AAI. 2,3 Compared with OC fusion, LC1-PC2 fixation does not limit the movement of the occiput-C1 complex, significantly improving postoperative satisfaction and neck mobility.…”

“…In addition to a longer wound incision, implant failure and postoperative dysphagia are other concerns with OC fusion 27 . Postoperative dysphagia after OC fusion occurred in 26% of patients, perhaps caused by hyperflexion or misalignment of the upper cervical spine during OC fusion, resulting in pharyngeal stenosis 28,29 …”