Whats New in Emergencies, Trauma and Shock? Addressing Cervical Spine Fractures.

The authors examine issues of dysphagia in patients presenting with traumatic cervical spine fractures at a level-1 trauma center. They examine mortality rates as well as discharge dispositions among elderly patients with cervical spine injury. As pointed out by the authors, dysphagia can be a challenging complication following a cervical spine injury, particularly in an elderly patient. In this study, the proportion of dysphagia patients that required short-term nasogastric feeding tubes and long-term feeding tubes were reported as 2.9–5.9%, respectively. The authors also report the use of halo devices in 3.7% of dysphagia patients and in 2.2% of nondysphagia patients. An important limitation to the interpretation of these results is that the study does not address the issue of temporality between the use of these devices (i.e., feeding tubes and halo immobilization device) and the onset of dysphagia. Whereas, the study by Garfin et al.[1] reported the finding of dysphagia as a complication that developed following the use of the halo immobilization device for stabilization of the cervical spine, it is difficult to draw any association in this study on whether the use of the halo device preceded the onset of dysphagia or vice versa. In addition from the study, it is unclear whether or not the onset of dysphagia preceded the use of the feeding tubes. Furthermore, in those patients that underwent spine surgery reported as 13.2%, it is also unclear whether dysphagia was diagnosed before or after surgery. Notably, the occurrence of dysphagia has been identified as a common complication in patients undergoing surgery following cervical spine injury.[23] It is hypothesized that retraction and manipulation of the pharynx during surgery may lead to bruising and injury to the pharyngeal musculature resulting in dysphagia. However, rates of dysphagia reported in patients undergoing surgery may vary depending on the surgical approach and technique used.[3]

Despite these significant limitations, it is commendable that the authors have taken on this very challenging topic in cervical spine trauma patients. The authors find increased length of hospital stay and higher rates of discharge to skilled nursing facilities, nursing homes, and long-term acute care facilities in patients who develop complications of dysphagia following cervical spine injury. Although most cases of dysphagia after cervical spine injury are frequently diagnosed as mild, patients may experience symptoms of dysphagia for variable duration which in some cases may be up to 2 years postsurgery.[4] All the same, as noted by the authors, additional long-term studies would be warranted to determine whether patients discharged to postacute care facilities were eventually discharged home and returned to their previous level of function.