The Impact Of Esophageal Manometry On Early Dysphagia After Anterior Cervical Surgery

Objective:To analysis the related factors of anterior cervical discectomy and fusion for esophagus motility and swallowing function by monitoring the chang of esophageal pressure.Methods:Altogether, 43 cases undergoing anterior cervical discectomy and fusion from july 2006 to july 2007 were doing esophageal manometry on three days after esophagus traction train and surgery. There were 24 males and 19females, with the mean age 53.5 years( range 37 to 75 years).Of these 43 patients, 5 were single surgical level, 22 were double surgical levels, 10 were three surgical levels, 5 were four surgical levels. 18 cases were general anesthesia, and 25 cases were plexus anesthesia. 29 cases had titanium plates placement, 6 cases had titanium plates and intervertebral cages, 8 cases had intervertebral cages placement. Univariate analysis was performed using the chi-square test. Age, gender, number of surgical levels, time of traction, hardware use were assessed to investigate the related impact factors.Results:There are 4 cases (23.5%) of older age-group(17) preoperative pressure lower than postoperative, and 21cases (23.5%) of middle age-group (26)preoperative pressure lower than postoperative. Age was significant for the change of esophagus motility. There were 24 males, and 14 (58.3%) of them preoperative pressure higher than postoperative. 19 cases were females, and 11(57.9%) of them preoperative pressure higher than postoperative. Gender was not statistically significant for the change of esophagus motility. The cases of preoperative pressure higher than postoperative pressure cases were 4, 17, 2, 2 which respectively belong to single surgical level(5), double surgical levels(22), there surgical levels(10), four surgical levels(6). The number of surgical levels was significant for the change of esophagus motility. 17 (58.6%) cases preoperative pressure higher than postoperative , which were included 29 cases who used titanium plates placement. 2 (33.3%) cases preoperative pressure higher than postoperative ,which were included 6 cases who used titanium plates and intervertebral cages placement. 6 (58.6%) cases preoperative pressure higher than postoperative pressure ,which were included 8 cases who used intervertebral cages placement. Hardware use was significant for the change of esophagus motility. 7 cases (38.9%) of general anesthesia (18) preoperative pressure lower than postoperative. And 18 cases (72%) of plexus anesthesia (25) preoperative pressure lower than postoperative. Anesthesia mode was significant for the change of esophagus motility.Conclusions:Age, number of surgical levels, time of traction, anesthesia mode was significant for the change of esophagus motility. There maybe two reasons lead to the change of esophagus pressure. First the surgery traction lead to the striated muscle of UES relaxation, and the pressure of the esophagus degraded. Secondly, local ischemia of the esophagus wall lead to hyperaemia and edema, which make the pressure higher. The hyperaemia and edema more dependability than the relaxation of striated muscle to the pressure change.