Dyspnea and Dysphagia after Posterior Atlantoaxial Instrumented Fusion

Ko, Hak Cheol; Lee, Tae One; Kim, Sung Min

Abstract

Dyspnea or dysphagia after occipitocervical fusion is well-known complications. It could be occurred when occipitocervical fusion is performed with the neck flexion position which leads to the narrowing of the airway and retropharyngeal space. However, we experienced a case of dyspnea and dysphagia after posterior C1-C2 fusion. A 68-year-old male showed no evidence of occipitocervical instability in preoperative studies. He complained of progressive dyspnea and dysphagia after C1-2 fusion and follow-up computed tomography (CT) and magnetic resonance (MRI) showed relatively narrow spinal canal at the level of C1-2 compared to preoperative studies and serial plain radiographic studies decreased occipitocervical (O-C2) angle gradually. Despite of conservative treatment, his symptom was not improved. So we did C1 posterior arch decompression and extended fusion to the occiput with neck extension position. Dyspnea and dysphagia gradually improved after the surgery and complete recovery was observed within a month. Though we did not know the causes of dyspnea and dysphagia exactly, two mechanisms were possible one was cord irritation due to anterior migration of C1 posterior arch after C1-2 fusion. The other was alar ligament disruption with microinstability between the occiput and atlas. We present the case of dyspnea and dysphagia after posterior C1-2 fusion.