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Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery
Author(s) -
Dhar Shumon I.,
Wegner Adam M.,
Rodnoi Pope,
Wuellner John C.,
Mehdizadeh Omid B.,
Shen Shih C.,
Nachalon Yuval,
NativZeltzer Nogah,
Klineberg Eric O.,
Belafsky Peter C.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28266
Subject(s) - diverticulum (mollusc) , medicine , swallowing , zenker's diverticulum , glottis , surgery , pharynx , dehiscence , larynx , dysphagia
Objectives A Zenker's diverticulum (ZD) is a hypopharyngeal pulsion diverticula caused by dysfunction of the cricopharyngeus muscle with herniation of hypopharyngeal mucosa through Killian's dehiscence. Anterior cervical spine surgery (ACSS) can cause a Zenker's‐like traction diverticulum (ZTD) with a similar presentation but different pathophysiology. The purpose of this investigation was to compare the fluoroscopic parameters and surgical outcomes of ZTD after ACSS to those of typical ZD. Study Design Case‐control study. Methods The charts of patients undergoing a videofluoroscopic swallow study after ACSS between January 1, 2014, and January 1, 2018, were evaluated for evidence of ZTD. Patients with ZTD were age and gender matched to persons with ZD. Fluoroscopic parameters and patient‐reported outcomes were compared between groups. Results Eleven patients with ZTD were identified. The mean pharyngeal constriction ratio (PCR) was significantly higher for persons with ZTD (0.87 [±0.07] vs. 0.17 [±0.08]; P < 0.05). Mean hyolaryngeal elevation was significantly less (2.5 [±0.9] cm vs. 3.5 [±0.7] cm) and mean diverticulum size significantly smaller (1.3 [±1.0] cm vs. 2.3 [±2.0] cm) for persons with ZTD ( P < 0.05). Five ZTD patients had exposed hardware necessitating open approach for removal. Conclusion We report the largest cohort of ZTD after ACSS. ZTD are smaller than traditional Zenker's and associated with more pharyngeal weakness, poorer laryngeal elevation, and worse treatment outcomes. Although these diverticula can be managed endoscopically, the high percentage of exposed cervical hardware necessitates a thorough preoperative assessment and frequent need for open management and pharyngeal repair. Level of Evidence 3b Laryngoscope, 130:1383–1387, 2020