The Risk of Dysphagia After Short-Segment Posterior Occipital-C2 Fusion versus C1-C2 Cervical Fusion: A Retrospective Cohort Study.

Abstract

We 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. This 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. There 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). Compared 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 III.