Dysphagia after C1-2 Posterior Fusion Surgery: A Case Report and Literature Review

Dysphagia involving the occipital bone is a critical complication after posterior fusion surgery. However, to our knowledge, dysphagia after posterior fixation of the cervical spine C1-2 has not been reported. Herein, we report a patient with dysphagia after posterior fusion of the cervical spine C1-2. The patient was a man in his 80s. He was referred to our department with a chief complaint of dexterity difficulty. After a thorough examination, we diagnosed subluxation of the atlantoaxial vertebrae and performed C1-2 posterior fusion surgery. Dysphagia appeared the day after surgery, which was thought to be caused by the change in cervical spine alignment after fixation surgery. The patient's dysphagia improved with continued rehabilitation without surgical treatment. The narrowest oropharyngeal airway space, occipital and external acoustic meatus to axis angle, pharyngeal inlet angle, and S-line were examined. We found that our patient had a low range of motion of the O-C1 joint and that compensation via mobility of the O-C1 joint was insufficient to compensate for the decrease in the O-C2 angle after C1-2 fixation. Preoperative evaluation of the O-C1 joint range of motion and increasing O-C2a from preoperative levels may be important for preventing dysphagia onset after posterior fixation of the cervical spine C1-2.