Clinical effect of occipito-cervical fusion and causes of postoperative dysphagia: a preliminary study_West China Medical Journal

Authors：

ZENG Yulin , WU Fan , WAN Shengyu , ZHANG Jian ,  LIN Xu , ZENG Jun , WU Chao , ZHONG Zeli , TAN Lun

Section I, Department of Orthopaedics, the Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

LIN Xu, Email: med_linxu@163.com

Keywords：

Occipital-cervical fusion; Occipital-cervical instability; Efficacy; Dysphagia

DOI：

10.7507/1002-0179.201907227

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the clinical effect of occipital-cervical fusion and its impact on cervical curvature, and preliminarily study the causes of postoperative dysphagia. Methods The data of 24 patients who underwent occipito-cervical fusion in the Fourth People’s Hospital of Zigong between January 2014 and December 2018 were retrospectively analyzed, including 13 males and 11 females, aged 33-82 years, with an average age of (58.3±13.3) years. Among them, there were 14 cases of atlas fractures, 6 cases of atlantoaxial fractures, 1 case of intraspinal canal space-occupying lesion, 2 cases of chronic atlantoaxial dislocation with spinal cord compression, and 1 case of instability caused by inflammatory diseases. Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) score were used to evaluate neurological function and pain of patients preoperatively and postoperatively. Occipito-cervical angle (O-C₂) and lower cervical angle (C₂-C₇) were measured to evaluate the preoperative and postoperative angle changes in patients. The causes of postoperative dysphagia were analyzed. Results All the 24 patients were followed up for 8-50 months (26.3 months on average). The mean JOA score increased from 11.6±1.5 before surgery to 15.4±1.2 at the last follow-up, and the mean VAS score decreased from 6.4±1.1 before surgery to 2.0±0.6 at the last follow-up; the differences between the two time points were statistically significant (P<0.001). The bone graft fusion rate was 95.8% (23/24). The mean O-C₂ angle decreased from (16.5±7.6)° before surgery to (14.7±4.5)° at the last follow-up, with no statistical significance (P=0.395). The mean angle of C₂-C₇ increased from (9.4±5.5)° before surgery to (16.3±3.5)° at the last follow-up, and the difference was statistically significant (P<0.001). Two patients developed postoperative dysphagia, possibly due to fusion in a flexion position. Conclusion Occipito-cervical fusion has reliable efficacy in treating occipito-cervical instability, with a high fusion rate and a low incidence of complications, but it will change the physiological curvature of upper and lower cervical vertebra, and fusion in a flexion position may cause postoperative dysphagia.

Citation： ZENG Yulin, WU Fan, WAN Shengyu, ZHANG Jian, LIN Xu, ZENG Jun, WU Chao, ZHONG Zeli, TAN Lun. Clinical effect of occipito-cervical fusion and causes of postoperative dysphagia: a preliminary study. West China Medical Journal, 2019, 34(9): 968-973. doi: 10.7507/1002-0179.201907227 Copy

1.	Maulucci C, Ghobrial G, Sharan A, et al. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion. Evid Based Spine Care J, 2014, 5(2): 163-165.
2.	宋瑞鹏. 枕颈融合术后并发下颈椎曲度异常的临床分析及三维有限元研究. 郑州: 郑州大学, 2016.
3.	Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
4.	S. A K W. Die leitungsbahnen des schmerzgefühls und die chirurgische behandlung der schmerzzustände. JAMA, 1927, 89(13): 1083-1084.
5.	Ding XJ, Abumi K, Ito M, et al. A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J, 2012, 21(8): 1580-1589.
6.	唐可, 卢雨霆, 张圆, 等. 枕颈融合术治疗枕颈失稳的临床疗效评价. 重庆医科大学学报, 2016(2): 151-155.
7.	Winegar CD, Lawrence JP, Friel BC, et al. A systematic review of occipital cervical fusion: techniques and outcomes: a review. J Neurosurg Spine, 2010, 13(1): 5-16.
8.	Abumi K, Avadhani A, Manu A, et al. Occipitocervical fusion. Eur Spine J, 2012, 43(1): 1.
9.	Sasso RC, Jeanneret B, Fischer K, et al. Occipitocervical fusion with posterior plate and screw instrumentation. A long-term follow-up study. Spine (Phila Pa 1976), 1994, 19(20): 2364-2368.
10.	Grob D, Dvorak J, Panjabi M, et al. Posterior occipitocervical fusion. A preliminary report of a new technique. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S17-S24.
11.	Smith MD, Anderson P, Grady MS. Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976), 1993, 18(14): 1984-1990.
12.	Lee SC, Chen JF, Lee ST. Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci, 2006, 13(2): 193-198.
13.	Nockels RP, Shaffrey CI, Kanter AS, et al. Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine, 2007, 7(2): 117-123.
14.	于杰, 陶晓晖, 靳培浩, 等. 颈椎后路手术后吞咽困难危险因素分析. 山东医药, 2016, 56(16): 40-42.
15.	Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976), 2004, 29(13): 1441-1446.
16.	Hong J, Lim S. Dysphagia after occipitocervical fusion. N Engl J Med, 2017, 376(22): e46.
17.	Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year follow-up study. Eur Spine J, 2005, 14(7): 677-682.
18.	Ota M, Neo M, Aoyama T, et al. Impact of the O-C2 angle on the oropharyngeal space in normal patients. Spine (Phila Pa 1976), 2011, 36(11): E720-E726.
19.	Miyata M, Neo M, Fujibayashi S, et al. O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion. Spine (Phila Pa 1976), 2009, 34(2): 184-188.
20.	Yoshida M, Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine (Phila Pa 1976), 2007, 32(8): E267-E270.
21.	Guo QF, Ni B, Yang J, et al. Relation between alignments of upper and subaxial cervical spine: a radiological study. Arch Orthop Trauma Surg, 2011, 131(6): 857-862.
22.	王圣林, 王超, Kirkham BW, 等. 寰枢关节不稳或脱位患者上颈椎曲度改变对下颈椎的影响. 中国脊柱脊髓杂志, 2009, 19(7): 502-505.
23.	张鹏. 枕颈融合术后下颈椎曲度异常的生物力学和临床研究. 上海: 中国人民解放军海军军医大学, 2018.

1. Maulucci C, Ghobrial G, Sharan A, et al. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion. Evid Based Spine Care J, 2014, 5(2): 163-165.
2. 宋瑞鹏. 枕颈融合术后并发下颈椎曲度异常的临床分析及三维有限元研究. 郑州: 郑州大学, 2016.
3. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
4. S. A K W. Die leitungsbahnen des schmerzgefühls und die chirurgische behandlung der schmerzzustände. JAMA, 1927, 89(13): 1083-1084.
5. Ding XJ, Abumi K, Ito M, et al. A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J, 2012, 21(8): 1580-1589.
6. 唐可, 卢雨霆, 张圆, 等. 枕颈融合术治疗枕颈失稳的临床疗效评价. 重庆医科大学学报, 2016(2): 151-155.
7. Winegar CD, Lawrence JP, Friel BC, et al. A systematic review of occipital cervical fusion: techniques and outcomes: a review. J Neurosurg Spine, 2010, 13(1): 5-16.
8. Abumi K, Avadhani A, Manu A, et al. Occipitocervical fusion. Eur Spine J, 2012, 43(1): 1.
9. Sasso RC, Jeanneret B, Fischer K, et al. Occipitocervical fusion with posterior plate and screw instrumentation. A long-term follow-up study. Spine (Phila Pa 1976), 1994, 19(20): 2364-2368.
10. Grob D, Dvorak J, Panjabi M, et al. Posterior occipitocervical fusion. A preliminary report of a new technique. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S17-S24.
11. Smith MD, Anderson P, Grady MS. Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976), 1993, 18(14): 1984-1990.
12. Lee SC, Chen JF, Lee ST. Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci, 2006, 13(2): 193-198.
13. Nockels RP, Shaffrey CI, Kanter AS, et al. Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine, 2007, 7(2): 117-123.
14. 于杰, 陶晓晖, 靳培浩, 等. 颈椎后路手术后吞咽困难危险因素分析. 山东医药, 2016, 56(16): 40-42.
15. Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976), 2004, 29(13): 1441-1446.
16. Hong J, Lim S. Dysphagia after occipitocervical fusion. N Engl J Med, 2017, 376(22): e46.
17. Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year follow-up study. Eur Spine J, 2005, 14(7): 677-682.
18. Ota M, Neo M, Aoyama T, et al. Impact of the O-C2 angle on the oropharyngeal space in normal patients. Spine (Phila Pa 1976), 2011, 36(11): E720-E726.
19. Miyata M, Neo M, Fujibayashi S, et al. O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion. Spine (Phila Pa 1976), 2009, 34(2): 184-188.
20. Yoshida M, Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine (Phila Pa 1976), 2007, 32(8): E267-E270.
21. Guo QF, Ni B, Yang J, et al. Relation between alignments of upper and subaxial cervical spine: a radiological study. Arch Orthop Trauma Surg, 2011, 131(6): 857-862.
22. 王圣林, 王超, Kirkham BW, 等. 寰枢关节不稳或脱位患者上颈椎曲度改变对下颈椎的影响. 中国脊柱脊髓杂志, 2009, 19(7): 502-505.
23. 张鹏. 枕颈融合术后下颈椎曲度异常的生物力学和临床研究. 上海: 中国人民解放军海军军医大学, 2018.

West China Medical Journal

Clinical effect of occipito-cervical fusion and causes of postoperative dysphagia: a preliminary study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content