The role of C2-7 angle in the development of dysphagia after anterior cervical spine surgery / 中华骨科杂志

ABSTRACT

Objective To analyze the relationship between cervical lordosis and the development of dysphagia after anterior cervical spine surgery.Methods From June 2007 to May 2010,data of 172 successive patients who had undergone ACDF operation in our hospital were reviewed in this study.The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview at least one year after the procedure.Plain cervical radiographs before and after surgery were collected.The C2-7 angle was measured.The change of C2-7 angle was defined as dC2-7 angle=postoperative C2-7-preoperative C2-7 angle.The correlation between postoperative dysphagia and dC2-7 angle was studied.Results There were 22 patients in dysphagia group,including 17 males and 5 females.Their age ranged from 25 to 70 years old,and average was 47.7±5.4.The average of BMI was 25.0±2.9 kg/m2.150 patients were in non-dysphagia group,including 101 males and 49 females.Their age ranged from 18 to 72 years old,and average age was 49.2±4.8.The average of BMI was 24.4±3.4 kg/m2.There was no statistical difference in gender,age,and BMI between two groups.The dC2-7 angle of dysphagia group ranged from-1 °-20.5°,and average was 8.6°±4.0°.The dC2-7 angle of non-dysphagia group ranged from-13°-28.5°,and average was 5.0°±4.3°.There was significant difference in dC2 7 angle between dysphagia and non-dysphagia group.Spearman Analysis revealed that there was strong correlativity between dC2-7 angle and postoperative dysphagia.When dC2-7 angle was greater than 5°,the chance of developing postoperative dysphagia significantly increased (19.3％ [17/88] vs 6.0％ [5/84]).What's more,Spearman Analysis also revealed that there was no correlativity between dC2 7 angle and degree of operative dysphagia.There was no significant difference in gender,age,and BMI between dysphagia and non-dysphagia group.There was no statistical difference in operative time,blood loss revision surgery,revision surgery ratio,most cephalic operative level and number of operative levels between dysphagia with non-dysphagia group.Logistic regression model showed that an increased likelihood of postoperative dysphagia persists with increasing dC2-7 angle,but had no relationship with operative time,blood loss,revision surgery,most cephalic operative level and number of operative levels.Conclusion dC2-7 angle may play an important role in the development of postoperative dysphagia.We found no statistical difference in operative time,blood loss revision surgery,revision surgery ratio,most cephalic operative level and number of operative levels between dysphagia and non-dysphagia group.Intraoperative measurement of the dC2-7 angle is practical and essential for reducing the postoperative dysphagia.