Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases
Abstract Objectives To analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis. Methods The case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) a...
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2025-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05516-6 |
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| author | Yufan Chen Weihong Xu |
| author_facet | Yufan Chen Weihong Xu |
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| description | Abstract Objectives To analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis. Methods The case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) and group B (non-dysphagia group) based on Bazaz scoring criteria. Baseline data and imaging parameters were collected: O-C2 angle, C2-7 angle, pharyngeal inlet angle (PIA), posterior occipital cervical angle (POCA), O-EA angle, Oc-Ax angle, Atlas-dens interval, C2-7 sagittal vertical axis (SVA), T1 slope, narrowest oropharyngeal airway space (nPAS), and thickness of the prevertebral soft tissue. Potential risk factors were identified via one-way intergroup comparisons and included in multivariable logistic regression analysis. Pearson or Spearman correlation analysis was performed to assess associations between dnPAS% and each parameter and inter-parameter correlations. Predictors were selected to plot receiver operating characteristic (ROC) curves for diagnostic evaluation. Prognosis was analyzed using the Kaplan-Meier method and curvilinear regression. Results Dysphagia occurred in 17 of 43 patients (39.53%). By the final follow-up (≥ 12 months), 11 patients (25.58%) had residual symptoms. Baseline factors, including dyspnea (P = 0.028), operative segment (P = 0.021), operative time (P = 0.006), anesthesia time (P = 0.025), solitude (P = 0.019), and satisfaction (P < 0.001), differed significantly between groups. Imaging parameters dO-C2a (P < 0.001), dPOCA (P < 0.001), PoPIA (P = 0.036), dPIA (P < 0.001), dOc-Axa (P = 0.001), dC2-7 SVA (P = 0.040), PonPAS (P = 0.004), dnPAS (P = 0.005), and dnPAS% (P < 0.001) were also significantly different. Multivariable regression analysis identified dPIA (OR = 0.870, P = 0.008) as an independent protective factor. ROC analysis showed dPIA had good diagnostic value (AUC = 0.855) with a cutoff of -8°. Prognostic analysis indicated rapid recovery was possible by 3 months postoperatively, with full recovery achieved in ~ 30% of patients by 1 year, after which recovery plateaued. Conclusion Postoperative dysphagia after OCF appears to result from multiple factors involving both “static + dynamic” elements. dPIA is a reliable predictor, with patients having a dPIA >-8° being less likely to develop dysphagia. However, only ~ 30% of patients achieve full recovery. |
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| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-6903d367765c4715815a1559c2b4f4e82025-01-26T12:43:24ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-01-0120111210.1186/s13018-025-05516-6Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 casesYufan Chen0Weihong Xu1Department of Orthopedics, Fujian Provincial Clinical Medical Research Center for Trauma Orthopedics Emergency and Rehabilitation, Fuzhou Second General HospitalDepartment of Spine Surgery, The First Affiliated Hospital of Fujian Medical UniversityAbstract Objectives To analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis. Methods The case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) and group B (non-dysphagia group) based on Bazaz scoring criteria. Baseline data and imaging parameters were collected: O-C2 angle, C2-7 angle, pharyngeal inlet angle (PIA), posterior occipital cervical angle (POCA), O-EA angle, Oc-Ax angle, Atlas-dens interval, C2-7 sagittal vertical axis (SVA), T1 slope, narrowest oropharyngeal airway space (nPAS), and thickness of the prevertebral soft tissue. Potential risk factors were identified via one-way intergroup comparisons and included in multivariable logistic regression analysis. Pearson or Spearman correlation analysis was performed to assess associations between dnPAS% and each parameter and inter-parameter correlations. Predictors were selected to plot receiver operating characteristic (ROC) curves for diagnostic evaluation. Prognosis was analyzed using the Kaplan-Meier method and curvilinear regression. Results Dysphagia occurred in 17 of 43 patients (39.53%). By the final follow-up (≥ 12 months), 11 patients (25.58%) had residual symptoms. Baseline factors, including dyspnea (P = 0.028), operative segment (P = 0.021), operative time (P = 0.006), anesthesia time (P = 0.025), solitude (P = 0.019), and satisfaction (P < 0.001), differed significantly between groups. Imaging parameters dO-C2a (P < 0.001), dPOCA (P < 0.001), PoPIA (P = 0.036), dPIA (P < 0.001), dOc-Axa (P = 0.001), dC2-7 SVA (P = 0.040), PonPAS (P = 0.004), dnPAS (P = 0.005), and dnPAS% (P < 0.001) were also significantly different. Multivariable regression analysis identified dPIA (OR = 0.870, P = 0.008) as an independent protective factor. ROC analysis showed dPIA had good diagnostic value (AUC = 0.855) with a cutoff of -8°. Prognostic analysis indicated rapid recovery was possible by 3 months postoperatively, with full recovery achieved in ~ 30% of patients by 1 year, after which recovery plateaued. Conclusion Postoperative dysphagia after OCF appears to result from multiple factors involving both “static + dynamic” elements. dPIA is a reliable predictor, with patients having a dPIA >-8° being less likely to develop dysphagia. However, only ~ 30% of patients achieve full recovery.https://doi.org/10.1186/s13018-025-05516-6Occipitocervical fusionDysphagiaCervical sagittal parametersPrognostic analysis |
| spellingShingle | Yufan Chen Weihong Xu Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases Journal of Orthopaedic Surgery and Research Occipitocervical fusion Dysphagia Cervical sagittal parameters Prognostic analysis |
| title | Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases |
| title_full | Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases |
| title_fullStr | Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases |
| title_full_unstemmed | Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases |
| title_short | Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases |
| title_sort | risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery a retrospective study of 43 cases |
| topic | Occipitocervical fusion Dysphagia Cervical sagittal parameters Prognostic analysis |
| url | https://doi.org/10.1186/s13018-025-05516-6 |
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