A new radiological parameter as a predictor of dysphagia based on oro-pharyngeal stenosis in a cohort of pediatric patients undergoing mal-reduced C1-2 pedicle screw fixation

Eur Spine J. 2022 Dec;31(12):3402-3409. doi: 10.1007/s00586-022-07355-z. Epub 2022 Oct 28.

Abstract

Purpose: C1 pedicle screw technique showed further advantages since it avoids the negative results from the sacrificed range of motion of the atlantooccipital joint compared to the occipitocervical fusion. However, some intractable complications are unavoidable. In the pediatric population, dysphagia after the atlantoaxial fixation can be accidentally serious. We aimed to determine the incidence of dysphagia in the pediatric population's cohort and its radiological predictor.

Methods: Between January 2010 and August 2018, this retrospective study included 42 pediatric patients with atlantoaxial dislocation due to trauma. They were followed up with an average duration of 8 years (range 5-18 years). Twenty-seven were males and 15 females with a mean age of 8.2 years (range 5-15 years) when undergoing operations. Patients were classified according to the presence of postoperative dysphagia according to the Bazaz dysphagia grading scale. The measurements, including pre- and postoperative CVT/NSL, O-C2, and C2-C7 sagittal angles, were performed.

Results: 26.2% of the patients (11/42) experienced postoperative dysphagia. A significant difference in the postoperative CVT/NSL (115.2 ± 13.2 vs.134.8 ± 17.3, P = 0.002), ΔCVT/NSL (7.0 ± 11.2 vs. 20.3 ± 10.5, P = 0.001), ΔO-C2 (- 3.2 ± 5.8 vs. 2.1 ± 5.1, P = 0.026), postoperative nPAS (9.4 ± 3.7 vs. 12.6 ± 4.2, P = 0.031) and ΔPAS (- 1.5 ± 4.1 vs. 2.0 ± 3.5, P = 0.010) between dysphagia group and non-dysphagia group were found. Adjustment for age, gender, and BMI, the multivariate logistic analysis showed that ΔCVT/NSL < 8.35° (OR = 5.23; 95% CI 4.97-5.50; P = 0.001) and ΔO-C2 (OR = 3.34; 95% CI 3.17-3.51; P = 0.001) remained associated with the occurrence of the swallowing problems.

Conclusion: In comparison with ΔO-C2, ΔCVT/NSL might better predict postoperative dysphagia in children.

Level of evidence i: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Keywords: Atlantoaxial fixation; Dysphagia; Postoperative complication; Radiologic parameter.

MeSH terms

  • Adolescent
  • Atlanto-Axial Joint* / diagnostic imaging
  • Atlanto-Axial Joint* / surgery
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / surgery
  • Child
  • Child, Preschool
  • Constriction, Pathologic
  • Cross-Sectional Studies
  • Deglutition Disorders* / diagnostic imaging
  • Deglutition Disorders* / epidemiology
  • Deglutition Disorders* / etiology
  • Female
  • Humans
  • Joint Instability* / surgery
  • Male
  • Pedicle Screws*
  • Retrospective Studies
  • Spinal Fusion* / adverse effects
  • Spinal Fusion* / methods