Dysphagia Following Anterior Approach Cervical Spinal Surgery in a Patient with Ankylosing Spondylitis.
- Author:
Wang Hyeon YUN
1
;
Jinyoung PARK
;
Joon Sang PARK
;
Doyoung KIM
;
Jung Hyun PARK
Author Information
1. Department of Rehabilitation Medicine Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea. RMPJH@yuhs.ac
- Publication Type:Case Report
- Keywords:
Ankylosing spondylitis;
Dysphagia;
Cervical vertebrae
- MeSH:
Cervical Vertebrae;
Deglutition;
Deglutition Disorders*;
Diskectomy;
Esophageal Sphincter, Upper;
Esophagus;
Female;
Humans;
Middle Aged;
Range of Motion, Articular;
Spine;
Spondylitis, Ankylosing*
- From:
Journal of the Korean Dysphagia Society
2018;8(2):117-120
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The known causes of dysphagia following cervical spine surgery include pre-vertebral soft tissue swelling, decreased posterior pharyngeal movement, and impaired upper esophageal sphincter opening. Some studies have suggested that dysphagia is associated with movement of the cervical vertebrae during swallowing. In the present case, a 59-year-old man with a limited cervical range of motion due to ankylosing spondylitis slipped and fell, resulting in a C7 vertebral body fracture. He underwent anterior cervical discectomy as well as C5-T1 anterior fusion and C5-T2 level postero-lateral fusion. After surgery, he showed signs and symptoms of aspiration. A video-fluoroscopic swallowing study (VFSS) revealed incomplete laryngeal elevation, cricopharyngeal dysfunction, and vallecular remnant. Aspiration was observed in the semisolid-swallowing test. The patient's dysphagia could be attributed to two main causes. First, the esophagus might have been compressed by thickened pre-vertebral soft tissue after surgery. Second, the cervical range of motion, which was already limited by ankylosing spondylitis, might have been limited further by the anterior fusion of the cervical spine. In conclusion, a preoperative evaluation, including VFSS, should be considered before cervical spinal surgery, particularly in patients with ankylosing spondylitis presenting with a limited cervical range of motion.