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Severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury: a case report and review of the literature.

Publication ,  Journal Article
Bekelis, K; Gottfried, ON; Wolinsky, J-P; Gokaslan, ZL; Omeis, I
Published in: Dysphagia
June 2010

There are only a few reports of dysphagia cases in patients who underwent surgery for posterior cervical fusion, but none provides an explanation for the occurrence of dysphagia. To the best of our knowledge this is the first case report showing evidence of severe neurogenic dysphagia, possibly secondary to vagal nerve praxia, in a patient who underwent posterior fusion. A 61-year-old man presented with severe neck pain after he sustained a fall. Imaging studies in the emergency department showed a C2 fracture associated with anterior subluxation of C2 on C3. Given the instability of the injury, a C1-C3 posterior cervical fusion was performed. The surgery was uneventful. The patient's postoperative course was complicated by severe dysphagia. Fluoroscopic and endoscopic assessments of the patient's pharynx and larynx showed significantly decreased epiglottic inversion, hypokinesis of his pharyngeal wall, and decreased hyolaryngeal elevation. There was also mild vocal cord paresis bilaterally, with incomplete approximation of the glottis. He demonstrated intra- and post-deglutitive aspiration. The patient coughed (both immediate and delayed) in response to the aspiration but was not able to clear aspirated material completely from the airway. The patient had a percutaneous endoscopic gastrostomy (PEG) tube placed to provide him with nutrition. He was then discharged home. On postoperative follow-up visit 1 month later, the patient's swallowing function improved and he could tolerate pureed consistencies and thin liquids with tube feed supplement. The patient could swallow without coughing. Possible causes of dysphagia in this case include traumatized airways from anesthesia, mechanical compromise of the upper gastrointestinal tract, and neurogenic dysphagia. After excluding the other possibilities, we concluded that our patient was suffering from neurogenic dysphagia associated with vagal nerve dysfunction.

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Published In

Dysphagia

DOI

EISSN

1432-0460

Publication Date

June 2010

Volume

25

Issue

2

Start / End Page

156 / 160

Location

United States

Related Subject Headings

  • Vagus Nerve
  • Spinal Fusion
  • Spinal Fractures
  • Speech-Language Pathology & Audiology
  • Severity of Illness Index
  • Risk Factors
  • Middle Aged
  • Male
  • Humans
  • Deglutition Disorders
 

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Bekelis, K., Gottfried, O. N., Wolinsky, J.-P., Gokaslan, Z. L., & Omeis, I. (2010). Severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury: a case report and review of the literature. Dysphagia, 25(2), 156–160. https://doi.org/10.1007/s00455-009-9255-7
Bekelis, Kimon, Oren N. Gottfried, Jean-Paul Wolinsky, Ziya L. Gokaslan, and Ibrahim Omeis. “Severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury: a case report and review of the literature.Dysphagia 25, no. 2 (June 2010): 156–60. https://doi.org/10.1007/s00455-009-9255-7.
Bekelis, Kimon, et al. “Severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury: a case report and review of the literature.Dysphagia, vol. 25, no. 2, June 2010, pp. 156–60. Pubmed, doi:10.1007/s00455-009-9255-7.
Journal cover image

Published In

Dysphagia

DOI

EISSN

1432-0460

Publication Date

June 2010

Volume

25

Issue

2

Start / End Page

156 / 160

Location

United States

Related Subject Headings

  • Vagus Nerve
  • Spinal Fusion
  • Spinal Fractures
  • Speech-Language Pathology & Audiology
  • Severity of Illness Index
  • Risk Factors
  • Middle Aged
  • Male
  • Humans
  • Deglutition Disorders