Predictive abilities of O-C2 angle, O-EA angle, and Oc-Ax angle for the development of dysphagia in patients after occipitocervical fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZOU Qiang ^1,2 , WANG Linnan ^1,2 ,  YANG Xi ^1,2 , SONG Yueming ^1,2 , LIU Limin ^1,2 , WANG Lei ^1,2 , ZHOU Zhongjie ^1,2 , HU Bowen ^1,2 , LIU Hao ^1,2 , CHEN Taiyong ^1,2

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Orthopedic Research Institute of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

YANG Xi, Email: formosa88@163.com

Keywords：

Occipitocervical fusion; dysphagia; occipitocervical angle; O-C2 angle; O-EA angle; Oc-Ax angle; nPAS; complication

DOI：

10.7507/1002-1892.202007113

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Objective To compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF).Methods Between April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF.Results Dysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group (χ²=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS (P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up (P>0.05). The differences in O-EAa and nPAS were significant (P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group (P>0.05); the difference in the O-C2a was significant (t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant (P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups (P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS (P<0.05). The dO-C2a≤−5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia (P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤−5° with a significant OR of 14.4.Conclusion The dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.

Citation： ZOU Qiang, WANG Linnan, YANG Xi, SONG Yueming, LIU Limin, WANG Lei, ZHOU Zhongjie, HU Bowen, LIU Hao, CHEN Taiyong. Predictive abilities of O-C2 angle, O-EA angle, and Oc-Ax angle for the development of dysphagia in patients after occipitocervical fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 33-38. doi: 10.7507/1002-1892.202007113 Copy

1.	Qureshi MA, Afzal W, Khalique AB, et al. Tuberculosis of the craniovertebral junction. Eur Spine J, 2013, 22(Suppl 4): 612-617.
2.	Winegar CD, Lawrence JP, Friel BC, et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine, 2010, 13(1): 5-16.
3.	Izeki M, Neo M, Ito H, et al. Reduction of atlantoaxial subluxation causes airway stenosis. Spine (Phila Pa 1976), 2013, 38(9): E513-E520.
4.	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.
5.	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.
6.	Morizane K, Takemoto M, Neo M, et al. Occipital and external acoustic meatus to axis angle as a predictor of the oropharyngeal space in healthy volunteers: a novel parameter for craniocervical junction alignment. Spine J, 2018, 18(5): 811-817.
7.	Nagashima S, Nagae M, Arai Y, et al. A new method of measuring the occipitocervical angle that could be applied as an intraoperative indicator during occipitocervical fusion. Clin Spine Surg, 2017, 30(7): E981-E987.
8.	Joaquim AF, Murar J, Savage JW, et al. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J, 2014, 14(9): 2246-2260.
9.	Meng Y, Wu T, Liu Z, et al. The impact of the difference in O-C2 angle in the development of dysphagia after occipitocervical fusion: a simulation study in normal volunteers combined with a case-control study. Spine J, 2018, 18(8): 1388-1397.
10.	Chen T, Yang X, Kong W, et al. Impact of the occiput and external acoustic meatus to axis angle on dysphagia in patients suffering from anterior atlantoaxial subluxation after occipitocervical fusion. Spine J, 2019, 19(8): 1362-1368.
11.	Tagawa T, Akeda K, Asanuma Y, et al. Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion. J Anesth, 2011, 25(1): 120-122.
12.	Ataka H, Tanno T, Miyashita T, et al. Occipitocervical fusion has potential to improve sleep apnea in patients with rheumatoid arthritis and upper cervical lesions. Spine (Phila Pa 1976), 2010, 35(19): E971-E975.
13.	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.
14.	Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine (Phila Pa 1976), 2001, 26(2): 161-165.
15.	Wang LN, Hu BW, Song YM, et al. Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion. Spine J, 2020, 20(5): 745-753.

1. Qureshi MA, Afzal W, Khalique AB, et al. Tuberculosis of the craniovertebral junction. Eur Spine J, 2013, 22(Suppl 4): 612-617.
2. Winegar CD, Lawrence JP, Friel BC, et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine, 2010, 13(1): 5-16.
3. Izeki M, Neo M, Ito H, et al. Reduction of atlantoaxial subluxation causes airway stenosis. Spine (Phila Pa 1976), 2013, 38(9): E513-E520.
4. 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.
5. 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.
6. Morizane K, Takemoto M, Neo M, et al. Occipital and external acoustic meatus to axis angle as a predictor of the oropharyngeal space in healthy volunteers: a novel parameter for craniocervical junction alignment. Spine J, 2018, 18(5): 811-817.
7. Nagashima S, Nagae M, Arai Y, et al. A new method of measuring the occipitocervical angle that could be applied as an intraoperative indicator during occipitocervical fusion. Clin Spine Surg, 2017, 30(7): E981-E987.
8. Joaquim AF, Murar J, Savage JW, et al. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J, 2014, 14(9): 2246-2260.
9. Meng Y, Wu T, Liu Z, et al. The impact of the difference in O-C2 angle in the development of dysphagia after occipitocervical fusion: a simulation study in normal volunteers combined with a case-control study. Spine J, 2018, 18(8): 1388-1397.
10. Chen T, Yang X, Kong W, et al. Impact of the occiput and external acoustic meatus to axis angle on dysphagia in patients suffering from anterior atlantoaxial subluxation after occipitocervical fusion. Spine J, 2019, 19(8): 1362-1368.
11. Tagawa T, Akeda K, Asanuma Y, et al. Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion. J Anesth, 2011, 25(1): 120-122.
12. Ataka H, Tanno T, Miyashita T, et al. Occipitocervical fusion has potential to improve sleep apnea in patients with rheumatoid arthritis and upper cervical lesions. Spine (Phila Pa 1976), 2010, 35(19): E971-E975.
13. 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.
14. Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine (Phila Pa 1976), 2001, 26(2): 161-165.
15. Wang LN, Hu BW, Song YM, et al. Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion. Spine J, 2020, 20(5): 745-753.

Chinese Journal of Reparative and Reconstructive Surgery

Predictive abilities of O-C2 angle, O-EA angle, and Oc-Ax angle for the development of dysphagia in patients after occipitocervical fusion

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