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High Resolution Manometry Analysis of a Patient With Dysphagia After Occiput-C3/4 Posterior Fusion Operation

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주제분류재활의학

초록

Many reports of changes in cervical alignment after posterior occipitocervical (O-C) fusion causing dysphagia are available. The clinical course can range from mild discomfort to severe aspiration. However, the underlying pathogenesis is not well known. We report an 80-year-old female with videofluoroscopic swallowing study evidence of aspiration that developed after occiput-C3/4 posterior fusion. Pharyngeal pressure was analyzed using high resolution manometry (HRM). Impaired upper esophageal sphincter opening along with diminished peristalsis and pharyngeal pressure gradient were revealed by HRM to be the main characteristics in such patients. The patient fully recovered after a revision operation for cervical angle correction. Distinct pressure patterns behind reversible dysphagia caused by a change in cervical alignment were confirmed using HRM analysis.

Abstract

Many reports of changes in cervical alignment after posterior occipitocervical (O-C) fusion causing dysphagia are available. The clinical course can range from mild discomfort to severe aspiration. However, the underlying pathogenesis is not well known. We report an 80-year-old female with videofluoroscopic swallowing study evidence of aspiration that developed after occiput-C3/4 posterior fusion. Pharyngeal pressure was analyzed using high resolution manometry (HRM). Impaired upper esophageal sphincter opening along with diminished peristalsis and pharyngeal pressure gradient were revealed by HRM to be the main characteristics in such patients. The patient fully recovered after a revision operation for cervical angle correction. Distinct pressure patterns behind reversible dysphagia caused by a change in cervical alignment were confirmed using HRM analysis.

참고문헌 (8)

  1. Izeki M, "The O-C2 angle established at occipitocervical fusion dictates the patient’s destiny in terms of postoperative dyspnea and", or dysphagia, 2014, pp.23, 328~336
  2. Tian W, "The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery", Dysphagia, 28, pp.131~138 (2013)
  3. Ota M, "Impact of the O-C2 angle on the oropharyngeal space in normal patients", Spine (Phila Pa 1976), 36, pp.E720~E726 (2011)
  4. Miyata M, "O-C2 angle as a predictor of dyspnea and", or dysphagia after occipitocervical fusion, 2009, pp.34, 184~188
  5. Fox MR, "Oesophageal high-resolution manometry: moving from research into clinical practice", Gut, 57, pp.405~423 (2008)
  6. Cook IJ, "Opening mechanisms of the human upper esophageal sphincter", Am J Physiol, 257(5Pt 1), pp.G748~G759 (1989)
  7. Gordon AM, "The variation in isometric tension with sarcomere length in vertebrate muscle fibres", J Physiol, 184, pp.170~192 (1966)
  8. Ren J, "Determinants of intrabolus pressure during esophageal peristaltic bolus transport", Am J Physiol, 264(3 Pt 1), pp.G407~G413 (1993)

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