I recently wrote a review of an article from the Dysphagia journal (June 2013) on the angle of C2-C7 in the development of dysphagia after cervical spine surgery. (See Link). There are many reasons for post-op dysphagia after cervical spine surgery in the literature, but this was the first time I had seen an investigation of angles and dysphagia. They used the Cobb Method in measuring the C2-C7 angle. A major limitation of the study design was the lack of instrumental swallowing evaluations.
Any other research re cervical spine angle / cervical lordosis and the development of dysphagia? Use of instrumental swallowing evaluations or ORL indirect laryngoscopy post-op? Prospective designs? Use of other angle measurement techniques to not underestimate or overestimate lordosis?
http://www.swallowstudy.com/?page_id=503
Hi Karen, interesting paper. As a clinician working in an orthopaedic hospital where they carry out cervical spine injury on traumatic patients (spinal cord injury) and kyphotics, we have seen some patients become aphagic post-op. Some are fixed so that their head looks to be in extension, which makes laryngeal elevation difficult. I'm not sure how the surgeons make their judgements on angle.
We tend to use flexible nasendoscopy/FEES as first investigation of swallowing function as it reveals laryngeal impairment and tests for sensation, providing a hint to the neurological involvement. Posterior pharyngeal wall oedema is transient but despite this dysphagia can persist. Sometimes this is just altered sensation (i.e feeling food stuck) but good function, and sometimes this is a real dysphagia often characterised by silent aspiration and difficulty even with secretion management.
I'd be interested in the responses you receive.
Best of luck
Jackie
Hello,
A physiotherapist I know has worked on dysphagia after cervical spine surgery, and dysphagia cause was due to nerve lesion or transitory inflammation. But I never heard about dysphagia and modified cervical spine angle. However, in my video fluoroscopic practice, I sometimes see modified cervical spine (arthritis, loss of lordosis…). And one would expect that an excessive cervical lordosis is deleterious for swallowing, due to airways exposure. So, it could be a nice topic.
[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)].
in lumbar surgery, a new index using lumbar lordosis and pelvic incidence is used. For cervical, probably we have to use occipital basis and cervical lordosis. In children, a study was made for atypical deglutition. They used an angle between skull and odontoid. (http://www.ncbi.nlm.nih.gov/pubmed/24946663)
For dysphagia evaluation, pretherapeutic functional testing, with V-VST for example, would be efficient. And determined angles of interest is necessary before prospective studies.
Keep me informed of the progress of your work.
Hi, Karen,
As a neurosurgeon, I think the main problem is not angles. The main problem is anteriorly osteophyte formation. I remember several nonoperated cases with . dysphagia . Osteophyte formation can compress oesaphagus easily if osteophyte formation reaches sufficiant volume. Lateral cervical XRay usually helps to understand the problem. In your article, there is C4-5 anteriorly placed osteophyte formation which compresses oesaphagus. This can be seen blockade of air column in oesaphagus. To solve the problem, sometimes surgery is needed.
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