Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun 8;1(1):e000001.
doi: 10.1136/tsaco-2016-000001. eCollection 2016.

Severe dysphagia requiring gastrostomy following cervical spine fracture fixation

Joanelle A Bailey  1 , Robert F Lavery  1 , John M Adams  2 , Andrew S Livingston  1 , Lou DiFazio  2 , David H Livingston  1
Affiliations

Severe dysphagia requiring gastrostomy following cervical spine fracture fixation

Joanelle A Bailey et al. Trauma Surg Acute Care Open. .

Abstract

Background: The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve quickly. We hypothesized that patient and clinical factors could be used to predict severe dysphagia requiring GT placement in this population.

Methods: A retrospective multicenter review of all adult patients requiring operative fixation of cervical spine fractures was performed. Data on demographics, injury severity score, presence of spinal cord injury, operative approach, presence of severe traumatic brain injury, and the need and timing of tracheostomy and GT were collected. The timing, number and results of formal speech, and language pathology examinations were also recorded.

Results: 243 patients underwent cervical spine fixation for traumatic fractures, of which 72 (30%) required GT placement. Patients requiring gastrostomy were significantly older, 54 versus 45 years (p=0.002), and had higher injury severity scores at 24 versus 18 (p<0.0001). Tracheostomy was strongly associated with severe dysphagia; GT was required in 83% of patients who underwent tracheostomy versus 5% of those who did not require tracheostomy. 50% of patients underwent tracheostomy and GT on the same day after injury, with the remaining patients having an average of 9 days delay between procedures. The need for gastrostomy placement was also higher in patients undergoing combined operative approach versus anterior or posterior approach alone (p=0.02). There were no GT-related complications.

Conclusions: Severe dysphagia requiring GT placement occurs commonly (30%) in patients who undergo operative fixation of cervical spine fractures. Gastrostomy placement was delayed in 50%. Tracheostomy was strongly associated with the need for GT placement. Earlier GT placement, especially in patients requiring tracheostomy, would improve patient care and disposition.

Keywords: cervical spine; dysphagia; fractures.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Lee MJ, Bazaz R, Furey CG, et al. . Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J 2007;7:141–7. doi:10.1016/j.spinee.2006.02.024 - DOI - PubMed
    1. Lee JY, Lim MR, Albert TJ. Dysphagia after anterior cervical spine surgery: pathophysiology, incidence, and prevention. Cervical Spine Res Soc 2005. http://www.csrs.org/wp-content/uploads/2014/06/dysphagia-outcome-study.pdf (accessed May 28, 2016). http://www.csrs.org/wp-content/uploads/2014/06/dysphagia-outcome-study.pdf
    1. Joaquim AF, Murar J, Savage JW, et al. . Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J 2014;14:2246–60. doi:10.1016/j.spinee.2014.03.030 - DOI - PubMed
    1. Rihn JA, Kane J, Albert TJ, et al. . What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res 2011;469:658–65. doi:10.1007/s11999-010-1731-8 - DOI - PMC - PubMed
    1. Riley LH III, Vaccaro AR, Dettori JR, et al. . Postoperative dysphagia in anterior cervical spine surgery. Spine 2010;35(9 Suppl):S76–85. doi:10.1097/BRS.0b013e3181d81a96 - DOI - PubMed

LinkOut - more resources