Jen Carter is a speech pathologist who has been treating adults with dysphagia for more than 20 years, including work at the University of Colorado Hospital and at the nationally renowned Craig Hospital in Denver.
Dysphagia following spine surgery
Did you know that having surgery on your spine can cause swallowing problems? Contrary to what you might expect, surgeons typically perform surgery on the cervical vertebrae (bones in the neck) by going through the front of the throat to get to the spine. Since all the muscles and nerves of the throat have to be rather significantly “moved out of the way” to get to the spine, some difficulty with voice and swallowing after surgery is fairly common.
Dr. Woosik Chung is a top-notch spinal surgeon in Denver, and I have treated several of his patients for swallowing difficulty after their surgeries. Every one of his patients that I’ve seen raves about how wonderful he is and how he is always smiling and jovial. Since that is often not the typical personality of a world-class surgeon, I was eager to meet this doctor who was reportedly not only a talented surgeon but a really nice guy as well. Last week I finally had a chance to meet Dr. Chung in person (who was every bit as nice as reported) when I was invited to attend his pre-op film rounds at the Colorado Spine Institute. When we were chatting at the end of rounds he invited me to observe cervical spinal surgery with him sometime so that by seeing actually what happens to a patient’s throat during surgery I could better understand exactly why they have swallowing problems. To say that I was thrilled at the invitation is an understatement. I was being given a chance to actually SEE, live and in 3-D, the muscles and structures that for 20 years of being a speech pathologist I have only been able to feel on a patient’s neck or at best see in a 2-D black and white x-ray. I could not get to the phone to call his scheduler fast enough.
When I got home that evening, I exclaimed to my non-medical, engineer husband “I get to observe spine surgery next week!” After he wrinkled his nose and said “sounds gross”, he told me to be careful not to drop any Junior Mints in the operating room (everything’s a Seinfeld reference).
So today I finally got my chance to see the anatomy of the throat, up close and personal. Dr. Chung was unbelievably welcoming to this speech pathologist in his OR. In addition to inviting to me ask any questions I had during the surgery (which I did), he had me peer over his shoulder several times as he pointed out the different layers of muscles as well as the trachea (windpipe) on his way toward the spine. For the delicate work of removing the herniated disc while not injuring the spinal cord, he and his PA were operating while looking through a microscope. At a few points Dr. Chung had me step in to look through the microscope while he had the PA point out different anatomical structures around the spine.
Not only was my experience in the OR extremely interesting, but I learned a thing or two that will be valuable to know when working with my patients after spinal surgery:
- I learned that unlike years past, the muscles of the throat are no longer cut during spinal surgery (at least not in Dr. Chung’s surgery). It took Dr. Chung quite a while to get down to the spine from the anterior neck because he was only cutting the fascia and connective tissue around the muscles and not the muscles themselves. This allowed him to just spread the muscles apart on his approach to the spine rather than slice through the muscles themselves. This technique is clearly more work for the surgeon than the old technique of cutting through the muscles, but what a difference it makes for patients in terms of muscle recovery. Good news for a clinician exercising the muscles of the throat for swallowing after surgery.
- I also learned that the likelihood of patients having voice problems after anterior spinal surgery due to injury to the recurrent laryngeal nerve is greatly reduced with new technology to monitor the patient during the procedure. A specialized neurologist in the OR was monitoring nerve activity with EMG to assure that no damage was done to the spinal nerves during surgery. Since this surgery was on vertebrae C5-7, the neurologist was monitoring nerve innervation of different muscles in the arm since the spinal nerves going to the arm originate from these vertebrae. This neurologist was also able to monitor the recurrent laryngeal nerve which provides neural innervation to the muscles of the larynx (voice box). In order to do this the breathing tube that is inserted into the throat during surgery has special electrodes on it to pick up any changes to recurrent laryngeal nerve as measured by changes at the vocal cords. If this doctor were to see any change in the vocal cords, then he could advise the surgeon so that he could make any necessary adjustments.
The whole experience observing spinal surgery completely exceeded all my expectations, and I am so appreciative to Dr. Chung and the OR staff for welcoming and accommodating this OR newbie!
image courtesy of Dr. Donald Corenman, MD – Spine Surgery Colorado