• Eur Spine J · Dec 2022

    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.

    • Gong Long, Zhu Yanfeng, Ma Haoning, Yi Ping, Tan Mingsheng, and Fang Zhiyuan.
    • Department of Orthopedic, Beijing Ji Shui Tan Hospital, 4th Clinical Hospital of Peking University, Beijing, 100035, China. Gonglong301@163.com.
    • Eur Spine J. 2022 Dec 1; 31 (12): 340234093402-3409.

    PurposeC1 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.MethodsBetween 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.Results26.2% 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.ConclusionIn comparison with ΔO-C2, ΔCVT/NSL might better predict postoperative dysphagia in children.Level Of Evidence IDiagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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