Swallowing function after occipitocervical arthrodesis for cervical deformity in patients with rheumatoid arthritis.
BACKGROUND
Some patients develop dysphagia after OC arthrodesis with RA. A previous report has indicated that establishing appropriate occipito-C2 is important for avoiding these side effects. However, a more recent report has demonstrated that the O-C2 angle did not have a significant effect on the incidence of postoperative dysphagia.


OBJECTIVE
To investigate the swallowing function of patients with rheumatoid arthritis (RA) before and after they underwent occipitocervical (OC) fusion.


METHODS
The study was performed in collaboration with the Departments of Orthopaedic, Otorhinolaryngology, and Rehabilitation. Seven consecutive patients (3 men and 4 women; mean age, 66.4 years) with RA-induced upper cervical deformity were enrolled from 2013 to 2014. The patients underwent deglutition analysis, which was performed by otorhinolaryngologists, before and after surgery, and comprised videofluoroscopy and fiberoptic endoscopy. We examined the relationship between imaging studies and swallowing function.


RESULTS
Preoperatively, subjective dysphagia was reported by 2 patients. Videofluoroscopy identified dysmotility of the epiglottis and incomplete closure of the laryngeal inlet in 2 patients, with contrast medium entering the larynx, and endoscopy identified food residue in the larynx of 1 patient during swallowing evaluation. Postoperatively, 2 patients with preoperative impaired deglutition showed dysphagia. Imaging examinations of the 2 patients revealed a 10°-reduction in the O-C2 angle of 1 patient, but the angle was unchanged in the other patient.


CONCLUSIONS
To the best of our knowledge, this is the first report to evaluate swallowing function before and after O-C3 arthrodesis. The preoperative O-C2 angle was unchanged after surgery. Impairment of deglutition may be closely associated with air leakage from the oropharynx due to impaired mobility of the soft palate. Because the precise mechanism of dysphagia has not been fully elucidated, further study using dynamic videofluoroscopy and videoendoscopy is needed to examine the swallowing mechanism.
Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.
Shigeto
S
Ebata
Department of Otorhinolaryngology, University of Yamanashi, Yamanashi, Japan.
Kyousuke
K
Hatsushika
Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.
Tetsuro
T
Ohba
Department of Otorhinolaryngology, University of Yamanashi, Yamanashi, Japan.
Kyohko
K
Nitta
Department of Rehabilitation, University of Yamanashi, Yamanashi, Japan.
Hiroshi
H
Akaike
Department of Otorhinolaryngology, University of Yamanashi, Yamanashi, Japan.
Keisuke
K
Masuyama
Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.|Department of Rehabilitation, University of Yamanashi, Yamanashi, Japan.
Hirotaka
H
Haro
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013123:Spinal Fusion / Q000009:adverse effects*
Rheumatoid arthritis; cervical deformity; deglutition; occipitocervical arthrodesis; videoendoscopic examination; videofluoroscopic examination