ABSTRACT
This aim of this study is to characterize the nature and pathophysiology of dysphagia after ACDF surgery by precisely and comprehensively capturing within-subject changes on videofluoroscopy between preoperative and postoperative time points. 21 adults undergoing planned primary ACDF procedures were prospectively recruited and enrolled. Participants underwent standardized preoperative and six-week postoperative videofluoroscopic swallow studies. Videos were blindly rated using the Penetration-Aspiration Scale (PAS) and analysis of total pharyngeal residue (%C2-42), swallowing timing, kinematics, and anatomic change was completed. Linear mixed-effects modeling was used to explore the relationships between possible predictor variables and functional outcomes of interest that changed across timepoints. There was no change in PAS scores across timepoints. Total pharyngeal residue (%C2-C42) was increased postoperatively (p < 0.001). Our statistical model revealed significant main effects for timepoint (p = 0.002), maximum pharyngeal constriction area (MPCAN) (p < 0.001), and maximum thickness of posterior pharyngeal (PPWTMAX) (p = 0.004) on the expression of total pharyngeal residue. There were significant two-way interactions for timepoint and MPCAN (p = 0.028), timepoint and PPWTMAX (p = 0.005), and MPCAN and PPWTMAX (p = 0.010). Unsurprisingly, we found a significant three-way interaction between these three predictors (p = 0.027). Our findings suggest that in planned ACDF procedures without known complications, swallowing efficiency is more likely to be impaired than airway protection six weeks after surgery. The manifestation of impaired swallowing efficiency at this timepoint appears to be driven by a complex relationship between reduced pharyngeal constriction and increased prevertebral edema.
Subject(s)
Cervical Vertebrae , Deglutition Disorders , Deglutition , Diskectomy , Postoperative Complications , Spinal Fusion , Humans , Male , Female , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Middle Aged , Deglutition/physiology , Spinal Fusion/adverse effects , Spinal Fusion/methods , Diskectomy/adverse effects , Diskectomy/methods , Cervical Vertebrae/surgery , Cervical Vertebrae/physiopathology , Prospective Studies , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Fluoroscopy/methods , Adult , Pharynx/physiopathology , Aged , Video Recording , Postoperative Period , Time FactorsABSTRACT
A method is described for the determination of lead in musts, wines and vinegars by atomic absorption spectroscopy. The method, already proposed as an official method both in Italy and at the O.I.V., gives sufficiently accurate and reproducible results and is particularly suitable for routine analysis. It has been tested on 120 white and red italian wines and has shown that lead pollution in wines has not reached dangerous limits.
