Skip to main content
SpringerLink
Log in

Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part II: perfusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Early postoperative dysphagia after anterior cervical surgery is a well-known phenomenon with so far unknown etiology. We hypothesised that direct pressure induced by the medial retractor blade on pharynx/esophagus mucosal wall leads to local ischemia. Subsequently postoperative hyperemia and swelling of the pharynx/esophagus may result in swallowing disturbance. To prove the hypothesis local blood flow inside the pharynx/esophagus wall during anterior cervical surgery was measured using a laser Doppler (LD) perfusion monitor unit. Fifteen patients underwent standard anterior cervical discectomy and fusion (ACDF). The LD probe was placed underneath the medial retractor blade in order to gain information at the maximum point of pressure applied onto the pharynx/esophagus wall. Local perfusion was measured prior to retractor opening (5 min), during spreading of the retractor and after its closure (5 min). Perfusion was measured semiquantitatively in perfusion units (PU). Local perfusion ranged from 30 to 210 PU (mean 107) prior to retractor opening, from 7 to 60 PU (mean 30) with open retractor and from 15 to 280 PU (mean 117) after retractor closure. In all 15 patients the open retractor led to hypoperfusion ranging from 21 to 93% compared to the baseline level. In seven patients a reactive hyperemia at the end of the procedure was detected (32–89% compared to baseline level). In four patients after hypoperfusion during spreading of the retractor the baseline levels were reached again and in four patients perfusion remained diminished even after retractor closure. To best of our knowledge, this is the first report on intraoperative measurement of local perfusion of the pharynx/esophagus wall during anterior cervical surgery. Diminished local perfusion was observed in all patients during spreading of the retractor and post-procedure hyperemia was recorded in 46% of the patients. The local ischemia of the pharynx/esophagus wall may be a crucial step in the development of postoperative dysphagia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ahn H, Ivarsson LE, Johansson K, Lindhagen J, Lundgren O (1988) Assessment of gastric blood flow with laser Doppler flowmetry. Scand J Gastroenterol 23:1203–1210

    PubMed  CAS  Google Scholar 

  2. Bazaz M, Lee M, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 27:2453–2458

    Article  PubMed  Google Scholar 

  3. Bose B (1998) Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol 49:25–31

    Article  PubMed  CAS  Google Scholar 

  4. Casadevall M, Panes J, Pique JM, Bosch J, Teres J, Rodes J (1992) Limitations of laser doppler velocimetry and reflectance spectrophotometry in estimating gastric mucosal blood flow. Am J Physiol 263:595–597

    Google Scholar 

  5. Edwards CC, Karpitskaya Y, Cha C, Heller JG, Lauryssen C, Yoon ST, Riew KD (2004) Accurate identification of adverse outcomes after cervical spine surgery. J Bone Joint Surg 86:251–256

    Article  PubMed  Google Scholar 

  6. Fogel GR, McDonnel MF (2005) Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J 5:140–144

    Article  PubMed  Google Scholar 

  7. Johansson K, Ahn H, Lindhagen J (1986) Assessment of small-bowel ischemia by laser doppler flowmetry. Scand J Gastroenterol 21:1147–1152

    PubMed  CAS  Google Scholar 

  8. Johansson K, Ahn H, Lindhagen J, Lundgren O (1987) Tissue penetration and measuring depth of laser Doppler flowmetry in the gastrointestinal application. Scand J Gastroenterol 22:1081–1088

    PubMed  CAS  Google Scholar 

  9. Krogh-Sörensen K, Line PD, Kvernebo K (1993) The significance of probe design in evaluation of colonic perfusion with laser doppler flowmetry. Scand J Gastroenterol 28:381–386

    PubMed  Google Scholar 

  10. Lee SK, Lee GY, Wong GT (2004) Prolonged and severe dysphagia following anterior cervical surgery. J Clin Neurosci 11:424–427

    Article  PubMed  Google Scholar 

  11. Ogata K, Whiteside LA (1982) Effects of external compression on blood flow to muscle and skin. Clin Orthop 168:105–107

    PubMed  Google Scholar 

  12. Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C (2002) Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg 97:176–179

    PubMed  Google Scholar 

  13. Schiebler TH, Schmidt W (1987) Lehrbuch der Anatomie des Menschen. Springer, Berlin Heidelberg New York

    Google Scholar 

  14. Shepherd AP, Riedel GK (1984) Differences in reactive hyperaemia between the intestinal mucosa and muscularis. Am J Physiol 247:617–622

    Google Scholar 

  15. Stewart M, Johnston RA, Steward I (1995) Swallowing performance following anterior cervical spine surgery. Br J Neurosurg 9:605–609

    Article  PubMed  CAS  Google Scholar 

  16. Styf JR, Willen J (1998) The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine 23:354–358

    Article  PubMed  CAS  Google Scholar 

  17. Taylor H, McGregor A, Medhi-Zadeh S, Richards S, Kahn N, Zadeh JA, Hughes S (2002) The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine 27:2758–2762

    Article  PubMed  Google Scholar 

  18. Winslow CP, Winslow TJ, Wax MK (2001) Dysphonia and dysphagia following the anterior approach to the cervical spine. Arch Otolaryngol Head Surg 127:51–55

    CAS  Google Scholar 

  19. Yue WM, Brodner W, Highland TR (2005) Persistent swallowing and voice problems after anterior cervical fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J 4 (in press)

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Oliver Heese, Erik Fritzsche, Manfred Westphal & Luca Papavero

  2. Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Max Heiland

Authors
  1. Oliver Heese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erik Fritzsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max Heiland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manfred Westphal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Papavero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliver Heese.

Additional information

Part I of this article can be found under http://dx.doi.org/10.1007/s00586-006-0069-0

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heese, O., Fritzsche, E., Heiland, M. et al. Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part II: perfusion. Eur Spine J 15, 1839–1843 (2006). https://doi.org/10.1007/s00586-006-0070-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-006-0070-7

Keywords

Search

Navigation