ArticleWorld neurosurgery2025
The Risk of Dysphagia After Short-Segment Posterior Occipital-C2 Fusion versus C1-C2 Cervical Fusion: A Retrospective Cohort Study.
Article in World neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveWe examined whether short-segment posterior occipital-C2 (O-C2) fusion is associated with a higher risk of postoperative dysphagia than short-segment posterior C1-C2 fusion to enhance preoperative education and shared decision-making.
methodsThis database study (TriNetX) included two cohorts (≥18 years old) who underwent either posterior O-C2 or C1-C2 fusion without extension into the subaxial cervical or thoracic spine. The primary outcome was the risk ratio (RR) of dysphagia, based on the incidence through 2 years. Secondary outcomes included RRs of potential oropharyngeal/respiratory complications and procedures.
resultsThere were 371 patients per cohort (mean age: 55 years). Comparing O-C2 to C1-C2 fusion through 2 years, there was a statistically significant increase in risk of dysphagia (RR: 1.97 [1.38, 2.82]; P < 0.001; 20.8% vs. 10.5%), with a median time to 50% of events of 11.0 days and 36.3 days, respectively. For secondary outcomes, there was a statistically significant increased risk of obstructive sleep apnea (RR: 2.07 [1.11, 3.86]; P = 0.018), speech therapy (RR: 2.04 [1.32, 3.16]; P = 0.001), and swallowing evaluation (RR: 1.85 [1.25, 2.74]; P = 0.002) and small nonsignificant increases in risk of dyspnea (RR: 1.30 [0.83, 2.05]; P = 0.255) and pneumonia (RR: 1.09 [0.63, 1.88]; P = 0.765).
conclusionsCompared to C1-C2 fusion, O-C2 fusion was associated with a nearly 2-fold increase in risk of dysphagia through 2 years, along with potential increases in other oropharyngeal and respiratory complications. Surgeons should be aware of these findings when planning O-C2 versus C1-C2 fusion. LEVEL OF EVIDENCE: Level III.
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