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Dysphagia following anterior cervical fusion.

The anterior approach to the cervical vertebrae can cause dysphagia via many mechanisms. These mechanisms include recurrent and/or superior laryngeal nerve injury, pharyngeal plexus injury, scarring of the pharynx itself, and the physical impeding of bolus transfer secondary to the presence of "hardware." The postoperative incidence of dysphagia following an anterior-approach cervical spine fusion has been reported to be 50.2% at 1 month, 32.2% at 2 months, 17.8% at 6 months, and 12.5% at 12 months. (1)

We evaluated a 44-year-old woman who had undergone a C4-C5 fusion 4 years earlier and revision surgery 2 1/2 years after the original surgery. Her complaints included a weak voice and swallowing difficulties with "choking" episodes. Transnasal endoscopic evaluation detected a left arytenoid granuloma and a marked protrusion in the posteriorpharyngeal wall (figure, A). Fiberoptic endoscopic evaluation of swallowing (FEES) revealed the presence of a moderate amount of postswallow residue superior to the protrusion, with all consistencies (figure, B). FEES also detected severe vallecular residue on solids after the swallow and trace aspiration of thin liquids. The source of the protrusion, which was believed to be the primary contributor to the patient's dysphagia, was the spinal fusion plate.

[FIGURE A OMITTED]

We have observed this type of mechanical obstruction to swallowing in several patients who had undergone anterior cervical fusion and who had been referred to our clinic by various institutions. In this patient, antireflux therapy and voice therapy were initiated to treat the granuloma. Dysphagia rehabilitation, including strengthening exercises to improve the patient's ability to achieve epiglottic retroversion and pharyngeal bolus propulsion, led to a decrease in the amount of residue after swallowing, eliminated the aspiration, and improved the patient's quality of life.

Reference

(1.) Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: A prospective study. Spine 2002;27:2453-8.

Susan G. Butler, PhD, CCC-SLP; Gregory N. Postma, MD; Stacey L. Halum, MD
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Title Annotation:DYSPHAGIA CLINIC
Author:Halum, Stacey L.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Apr 1, 2005
Words:323
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