Miura Kousei, Koda Masao, Funayama Toru, Takahashi Hiroshi, Yamazaki Masashi
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN.
Cureus. 2020 Dec 3;12(12):e11881. doi: 10.7759/cureus.11881.
Occipito-cervical fusion surgery may cause dysphagia due to inadequate occipito-cervical alignment. However, little is known about any other mechanisms behind postoperative dysphagia. We present a rare case of severe sarcopenic dysphagia despite appropriate occipito-cervical alignment after occipito-cervical fusion surgery. An 85-year-old man who presented with high-cervical myelopathy due to a retro-odontoid pseudotumor underwent occipito-cervical fusion surgery and developed severe dysphagia immediately after the surgery. Swallowing videoendoscopy revealed stagnation of thick fluid at the larynx. Oral intake was prohibited and swallowing rehabilitation was performed. Subsequently, he showed a gradual improvement in swallowing function. He was allowed to start oral intake in the fourth week after surgery and was able to swallow solid foods in the sixth week after surgery. In this case, several parameters of occipito-cervical alignment such as the occipito-C2 angle (O-C2 angle), swallowing line (S-line), C2-C7 angle, and pharyngeal inlet angle, which are recognized as predictors of postoperative dysphagia after occipito-cervical fusion surgery, were adequate to prevent postoperative dysphagia. However, the patient had sarcopenia and cervical hyperlordosis to compensate for thoracic hyperkyphosis, which induces the hypertonicity of hyoid muscles. These findings led to a diagnosis of sarcopenic dysphagia after surgical invasion. Sarcopenic dysphagia is considered to be associated with skeletal and swallowing muscle weakness, apart from thinness, malnutrition, and surgical invasion. Elderly patients with sarcopenia may present with sarcopenic dysphagia because of surgical invasion after occipito-cervical fusion surgery. In such cases, it is important not only to control intraoperative occipito-cervical alignment but also to evaluate preoperative swallowing function.
枕颈融合手术可能因枕颈对线不佳而导致吞咽困难。然而，关于术后吞咽困难背后的任何其他机制知之甚少。我们报告一例罕见的病例，患者在枕颈融合手术后尽管枕颈对线良好，但仍出现严重的肌少症性吞咽困难。一名85岁男性因齿突后假瘤导致高位颈髓病，接受了枕颈融合手术，术后立即出现严重吞咽困难。吞咽视频内镜检查显示厚流质在喉部停滞。禁止经口进食并进行吞咽康复治疗。随后，他的吞咽功能逐渐改善。术后第四周允许他开始经口进食，术后第六周能够吞咽固体食物。在该病例中，枕颈对线的几个参数，如枕骨 - C2角（O - C2角）、吞咽线（S线）、C2 - C7角和咽入口角，这些被认为是枕颈融合手术后术后吞咽困难的预测指标，足以预防术后吞咽困难。然而，该患者存在肌少症和颈椎前凸以代偿胸椎后凸，这导致舌骨肌张力亢进。这些发现导致诊断为手术侵袭后肌少症性吞咽困难。肌少症性吞咽困难被认为与骨骼和吞咽肌肉无力有关，与消瘦、营养不良和手术侵袭无关。患有肌少症的老年患者在枕颈融合手术后可能因手术侵袭而出现肌少症性吞咽困难。在这种情况下，不仅要控制术中枕颈对线，还应评估术前吞咽功能。
