J Korean Med Sci.  2016 Dec;31(12):2020-2025. 10.3346/jkms.2016.31.12.2020.

Swallowing Function Defined by Videofluoroscopic Swallowing Studies after Anterior Cervical Discectomy and Fusion: a Prospective Study

• Kang SH
• Kim DK
• Seo KM
• Lee SY
• Park SW
• Kim YB

• KMID: 2355634
• DOI: http://doi.org/10.3346/jkms.2016.31.12.2020

Abstract

This study evaluated factors related to swallowing dysfunction after anterior cervical discectomy and fusion (ACDF) using videofluoroscopic swallowing studies (VFSS). Preoperative and postoperative VFSSs were done with 5 mL diluted barium. Oral transit time, pharyngeal delay time, pharyngeal response time (PRT), and pharyngeal transit time were measured. Hyoid bone movement and upper esophageal sphincter (UES) diameter were measured serially. Thickness of prevertebral soft tissue was measured from digitized VFSS images. In results, 12 of 20 patients showed abnormal postoperative VFSS findings. PRT decreased significantly after surgery. Hyoid bone movement did not change significantly after surgery. The maximal distance of UES opening decreased significantly after surgery, and the higher the level of surgery (C3 > C4 > C5 > C6), the greater the decrease in maximal distance of the UES opening after surgery. The time to widest opening of the UES was prolonged significantly. At the C3 and C4 levels, the change in prevertebral soft tissue thickness of patients with VFSS abnormalities was significantly greater than those without abnormalities. In conclusion, patients after ADCF with their highest surgery level at C3 and C4 showed more abnormal VFSS findings, significantly increased soft tissue thickness, and decreased maximal distance of UES opening. VFSS provided objective data related with swallowing dysfunction after ACDF.

Keyword

Dysphagia; Swallowing; Fluoroscopy; Spine; Surgery; Upper Esophageal Sphincter

MeSH Terms

Barium
Deglutition Disorders
Deglutition*
Diskectomy*
Esophageal Sphincter, Upper
Fluoroscopy
Humans
Hyoid Bone
Prospective Studies*
Reaction Time
Spine
Barium

Figure

• 

  Fig. 1 Videofluoroscopic swallowing study (VFSS) measurements. (A) Prevertebral soft tissue thickness was measured from the anterior aspect of the cervical vertebra to the barium line inside the esophagus. The red lines are distance from each cervical vertebra to this barium line. (B) Hyoid bone displacement was measured from VFSS images, which were processed using the Image J program. The y-axis was created from a straight line between the anterior–inferior points of C4 and C2, and the x-axis was created as a perpendicular line from the anterior and inferior point of C4 (red long arrows). The position of the hyoid (red dot, indicated by the yellow arrow) was calculated as X and Y coordinates. (C) The opening of the upper esophageal sphincter was measured serially frame by frame, and the measurement point was 1.5 cm below the lower hypopharynx (indicated by yellow arrow).

• 

  Fig. 2 Analysis of prevertebral soft tissue thickness. Prevertebral soft tissue thickness increased at all cervical levels (C3–C6) after surgery, and the percentages of increase were 115.33% at C3, 81.80% at C4, 68.05% at C5, and 84.60% at C6 (A). The degrees of increase at each level were not significant between the dysphagia and non-dysphagia groups immediately after surgery (B) or 1 month after surgery (C). The increase in prevertebral soft tissue thickness at C3 and C4 was significantly greater in the abnormal videofluoroscopic swallowing study (VFSS) group than that in the normal VFSS group (D).

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