Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation

Abstract

The halo-vest brace has been a common mode for immobilization of the cervical spine. The incidence of complications such as pin loosing and infection are known in patients with halo-vest fixation. Dysphagia is one of the most serious complications seen with the use of a halo-vest brace. The aim of this study was to elucidate factors associated with the incidence of dysphagia in patients treated using a halo-vest brace in terms of not only demographic data, but also radiological findings of the cervical spine. We retrospectively reviewed medical records and radiological measurements using lateral plain X-rays of the cervical spine in patients who had undergone halo-vest fixation in our institute between January 2006 and August 2016. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS) from medical records. Patients were classified into non-dysphagia (FILS level: 10) and dysphagia (FILS level: 1–9) groups. Forty-three patients were attributed for analysis. Twenty-eight patients were classified into non-dysphagia group, 15 patients were classified into dysphagia group. Mean age was grater ( P = 0.041), length of ICU stay was longer ( P = 0.002), and frequency of tracheostomy was larger ( P = 0.043) in the dysphagia group. Mean O-C2 angle was smaller in the dysphagia group ( P = 0.027). Body mass index [odds ratio (OR) = 0.522, 95% confidence interval (CI) = 0.377–0.934, P = 0.024], ICU stay (OR = 1.302, 95% CI = 1.272–10.624, P = 0.016), and O-C2 angle (OR = 0.911, 95% CI = 0.833–0.996, P = 0.041) remained independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative linear correlation between ICU stay and FILS level ( r = 0.476, P = 0.001) and a positive linear correlation between O-C2 angle and FILS level ( r = 0.385, P = 0.011). This study suggested the significance of O-C2 angle as well as ICU stay for incidence and severity of dysphagia in patients with halo-vest fixation.