Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery

Shumon I. Dhar, Adam M. Wegner, Pope Rodnoi, John C. Wuellner, Omid B. Mehdizadeh, Shih C. Shen, Yuval Nachalon, Nogah Nativ-Zeltzer, Eric Otto Klineberg, Peter C Belafsky

Research output: Contribution to journalArticle

Abstract

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, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Zenker Diverticulum
Diverticulum
Deglutition
Traction
Spine
Pharyngeal Muscles
Laryngoscopes
Needs Assessment
Constriction

Keywords

  • outcomes
  • Swallowing/dysphagia
  • traction diverticulum
  • Zenker's diverticulum

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Dhar, S. I., Wegner, A. M., Rodnoi, P., Wuellner, J. C., Mehdizadeh, O. B., Shen, S. C., ... Belafsky, P. C. (Accepted/In press). Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery. Laryngoscope. https://doi.org/10.1002/lary.28266

Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery. / Dhar, Shumon I.; Wegner, Adam M.; Rodnoi, Pope; Wuellner, John C.; Mehdizadeh, Omid B.; Shen, Shih C.; Nachalon, Yuval; Nativ-Zeltzer, Nogah; Klineberg, Eric Otto; Belafsky, Peter C.

In: Laryngoscope, 01.01.2019.

Research output: Contribution to journalArticle

Dhar, SI, Wegner, AM, Rodnoi, P, Wuellner, JC, Mehdizadeh, OB, Shen, SC, Nachalon, Y, Nativ-Zeltzer, N, Klineberg, EO & Belafsky, PC 2019, 'Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery', Laryngoscope. https://doi.org/10.1002/lary.28266
Dhar, Shumon I. ; Wegner, Adam M. ; Rodnoi, Pope ; Wuellner, John C. ; Mehdizadeh, Omid B. ; Shen, Shih C. ; Nachalon, Yuval ; Nativ-Zeltzer, Nogah ; Klineberg, Eric Otto ; Belafsky, Peter C. / Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery. In: Laryngoscope. 2019.
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title = "Swallowing Characteristics in Zenker's-like Diverticulum After Anterior Cervical Spine Surgery",
abstract = "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, 2019.",
keywords = "outcomes, Swallowing/dysphagia, traction diverticulum, Zenker's diverticulum",
author = "Dhar, {Shumon I.} and Wegner, {Adam M.} and Pope Rodnoi and Wuellner, {John C.} and Mehdizadeh, {Omid B.} and Shen, {Shih C.} and Yuval Nachalon and Nogah Nativ-Zeltzer and Klineberg, {Eric Otto} and Belafsky, {Peter C}",
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AU - Dhar, Shumon I.

AU - Wegner, Adam M.

AU - Rodnoi, Pope

AU - Wuellner, John C.

AU - Mehdizadeh, Omid B.

AU - Shen, Shih C.

AU - Nachalon, Yuval

AU - Nativ-Zeltzer, Nogah

AU - Klineberg, Eric Otto

AU - Belafsky, Peter C

PY - 2019/1/1

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N2 - 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, 2019.

AB - 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, 2019.

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KW - Swallowing/dysphagia

KW - traction diverticulum

KW - Zenker's diverticulum

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