Risk factors of dysphagia in patients with ossification of the anterior longitudinal ligament

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 28; no. 3; p. 2309499020960564
• Main Authors: Nishimura, Hirosuke, Endo, Kenji, Aihara, Takato, Murata, Kazuma, Suzuki, Hidekazu, Matsuoka, Yuji, Takamatsu, Taichiro, Maekawa, Asato, Sawaji, Yasunobu, Tsuji, Hanako, Yamamoto, Kengo
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2020; SAGE Publishing
• Subjects: cervical spine; cervical lordosis; dysphagia; pharyngeal inlet angle; ossification of the anterior longitudinal ligament; O–C2 angle; deglutition disorders
• ISSN: 2309-4990; 1022-5536; 2309-4990
• DOI: 10.1177/2309499020960564

Introduction:
Cervical ossification of the anterior longitudinal ligament (OALL) occasionally leads to dysphagia by the anterior osteophyte. A recent report explained that the dysphagia after an occipito-cervical fusion is caused by the narrowing of pharyngeal space due to the cranio-cervical malalignment. The purpose of this study was to evaluate the cranio-cervical alignment in patients with OALL complaining of the dysphagia.
Subjects and methods:
The subjects were 11 cases with complaining of dysphagia due to cervical OALL who underwent anterior cervical OALL resection and as control, age-matched 12 cases without dysphagia who have diffuse idiopathic skeletal hyperostosis in cervical spine. All subjects were male, and the mean age was 59.5 ± 9.1 years. The subjects were divided into two groups according to the symptoms of dysphagia (dysphagia, group A; control, group B). The O–C2 angle, C2–C7 angle, and the maximum thickness of OALL and the cranio-cervical alignment (pharyngeal inlet angle; PIA) and swallowing line (S-line) were measured before and after the operation on the lateral cervical radiogram at the sitting position.
Results:
Group A showed significantly large maximum thickness of OALL, small cervical range of motion, small O–C2 angle, large C2–C7 angle, and small PIA. The S-line crossed the anterior apex of cervical osteophyte in group A. After OALL resection, dysphagia had improved, PIA had increased, and the S-line uncrossed the apex of cervical vertebrae in all cases.
Conclusion:
The prevalence of dysphagia in patients with cervical OALL was influenced by the thickness of osteophyte, cervical mobility, and cranio-cervical alignment.