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dysphagia

Dysphagia

Esophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids, although, so far, there are no scientific study that proves that those thickened liquids are beneficial.

Although recombinant human Bone morphogenetic protein 2 is effective in promoting arthrodesis, many physicians avoid using it in Anterior Cervical Spine Surgery due to concern for increased incidence of dysphagia, significant pre-vertebral swelling, and airway compromise. Pilot studies have shown that the local application of depomedrol may decrease the incidence of postoperative dysphagia.

A study provides Level of evidence 1 that locally administered depomedrol on a collagen sponge significantly decreases postoperative dysphagia incidence and magnitude following anterior cervical spine fusion using low-dose rhBMP-2 1).

Etiology

Anterior cervical discectomy

Cervical anterior osteophyte.

Dysphagia may manifest as the result of autonomic nervous system pathologies including stroke and ALS, or due to rapid iatrogenic correction of an electrolyte imbalance.

Severe dysphagia and odynophagia are post-ACDF complications. In most instances they are attributable to prevertebral soft-tissue edema accompanied by inflammatory responses such as fever and an increase in the white blood cell count and in C-reactive protein. In other cases these anomalies are elicited by hematoma not associated with inflammation 2).

1)
Edwards CC 2nd, Dean C, Edwards CC, Phillips D, Blight A. Can Dysphagia Following Anterior Cervical Fusions With rhBMP-2 Be Reduced With Local Depomedrol Application?: A Prospective, Randomized, Placebo-Controlled, Double-Blind Trial. Spine (Phila Pa 1976). 2016 Apr;41(7):555-62. doi: 10.1097/BRS.0000000000001284. PubMed PMID: 27018896.
2)
Yagi K, Nakagawa H, Okazaki T, Irie S, Inagaki T, Saito O, Nagahiro S, Saito K. Noninfectious prevertebral soft-tissue inflammation and hematoma eliciting swelling after anterior cervical discectomy and fusion. J Neurosurg Spine. 2017 Jan 13:1-7. doi: 10.3171/2016.9.SPINE16520. [Epub ahead of print] PubMed PMID: 28084931.
dysphagia.txt · Last modified: 2017/01/19 13:14 (external edit)