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

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 lin...

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Autores principales: Tatter, Charles, El-Hajj, Victor Gabriel, Fletcher-Sandersjöö, Alexander, Edström, Erik, Elmi-Terander, Adrian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140007/
https://www.ncbi.nlm.nih.gov/pubmed/36781463
http://dx.doi.org/10.1007/s00701-023-05509-6
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author Tatter, Charles
El-Hajj, Victor Gabriel
Fletcher-Sandersjöö, Alexander
Edström, Erik
Elmi-Terander, Adrian
author_facet Tatter, Charles
El-Hajj, Victor Gabriel
Fletcher-Sandersjöö, Alexander
Edström, Erik
Elmi-Terander, Adrian
author_sort Tatter, Charles
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-023-05509-6.
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spelling pubmed-101400072023-04-29 Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review Tatter, Charles El-Hajj, Victor Gabriel Fletcher-Sandersjöö, Alexander Edström, Erik Elmi-Terander, Adrian Acta Neurochir (Wien) Review Article - Spine - Other 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-023-05509-6. Springer Vienna 2023-02-14 2023 /pmc/articles/PMC10140007/ /pubmed/36781463 http://dx.doi.org/10.1007/s00701-023-05509-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review Article - Spine - Other
Tatter, Charles
El-Hajj, Victor Gabriel
Fletcher-Sandersjöö, Alexander
Edström, Erik
Elmi-Terander, Adrian
Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title_full Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title_fullStr Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title_full_unstemmed Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title_short Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
title_sort radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review
topic Review Article - Spine - Other
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140007/
https://www.ncbi.nlm.nih.gov/pubmed/36781463
http://dx.doi.org/10.1007/s00701-023-05509-6
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