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Considerations in revising occipitocervical fixation for dysphagia
Mazhar Iqbal1, K Joshi George1
1Department of Neurosurgery, Salford Royal Hospital, Stott Lane, Salford, Manchester, M6 8HD, England, United Kingdom.
Surgical Neurology International
|April 21, 2021
Summary
Revision surgery effectively treated dysphagia after occipitocervical fixation (OCF) for C1/C2 instability. Shortening the cranial construct improved swallowing, posture, and head movement, offering a feasible solution for complex cases.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Dysphagia is a complex complication following occipitocervical fixation (OCF).
- Revision surgery for OCF-induced dysphagia presents significant decision-making challenges.
- Pathogenesis and surgical strategies for OCF-related dysphagia are explored.
Purpose of the Study:
- To present a novel surgical strategy for managing dysphagia after OCF.
- To evaluate the efficacy of revision surgery involving shortening the rostral construct.
Main Methods:
- Two cases of dysphagia post-OCF for C1/C2 instability were analyzed.
- Revision surgery involved removing cranial fixation and performing C1 fusion.
- Preoperative imaging to assess craniocervical angle was unavailable.
Main Results:
- Both patients experienced dysphagia recovery after revision surgery.
- Patients reported improved weight, posture, and head movement satisfaction.
- Enhanced forward gaze and head position were noted post-revision.
Conclusions:
- C1/C2 fusion is preferred over OCF for C1/C2 instability.
- Maintaining the preoperative O-C2 angle during OCF is crucial.
- Shortening the rostral construct via C1 fusion is a feasible and effective treatment for OCF-induced dysphagia.
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