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Trashin AV, Vikherev NV, Belov EM, Shamanin VA, Stepanenko VV. [Dysphagia as the main symptom in anterior cervical spine osteophytes (Forestier disease and cervical spondylosis deformans). Case reports and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:69-76. [PMID: 38549413 DOI: 10.17116/neiro20248802169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Anterior cervical osteophytes are a fairly common X-ray finding in people over 50 years old. Incidence of dysphagia in patients with anterior osteophytes varies from 1% in those aged 40-60 years to 10.6% in patients over 60 years old. The most common causes of anterior cervical hyperosteophytosis causing dysphagia are cervical spondylosis deformans and Forestier disease. We present 2 clinical cases of spondylogenic dysphagia in cervical spondylosis deformans and Forestier disease. The review is devoted to the causes and diagnostic methods for dysphagia caused by anterior cervical osteophytes, as well as surgical options for this pathology. CONCLUSION Microsurgical resection of anterior osteophytes is an effective method for dysphagia after ineffective therapy for 3 months. Microsurgical osteophytectomy provides stable regression of dysphagia with low recurrence rate.
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Affiliation(s)
- A V Trashin
- St. Petersburg City Multi-field Hospital No. 2, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - N V Vikherev
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - E M Belov
- St. Petersburg City Multi-field Hospital No. 2, St. Petersburg, Russia
| | - V A Shamanin
- St. Petersburg City Multi-field Hospital No. 2, St. Petersburg, Russia
| | - V V Stepanenko
- St. Petersburg City Multi-field Hospital No. 2, St. Petersburg, Russia
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2
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Walters RK, Gudipudi R, Davidson K, Cooke M, Barengo J, Smyre D, Garand KL, Martin-Harris B, Matheus MG, Nguyen SA, O'Rourke AK. The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:565-575. [PMID: 36749843 PMCID: PMC10171843 DOI: 10.1044/2022_ajslp-22-00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 11/23/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Spinal pathology is very common with advancing age and can cause dysphagia; however, it is unclear how frequently these pathologies affect swallowing function. This study evaluates how cervical spinal pathology may impact swallowing function in dysphagic individuals observed during videofluoroscopic swallowing studies (VFSSs). METHOD A retrospective case-control study was performed on 100 individuals with dysphagia as well as age-/gender-matched healthy controls (HCs) with available VFSS. Spinal anatomy of patients was classified into two predetermined categories, and a consensus decision of whether spinal pathology influenced swallowing physiology was made. Validated swallow metrics, including Modified Barium Swallow Impairment Profile (MBSImP) component scores, Penetration-Aspiration Scale (PAS) maximum scores, and 10-item Eating Assessment Tool (EAT-10) scores, were compared between the spine-associated dysphagia (SAD), non-SAD (NSAD), and HC groups using Kruskal-Wallis one-way analysis of variance. RESULTS Most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary etiology of dysphagia in 16.9% of patients with abnormal spine pathology. Median EAT-10 scores were statistically different among the three groups, with the NSAD group scoring the highest and the HC group scoring the lowest. Similarly, median PAS scores were significantly different between dysphagic groups and HCs. Median MBSImP Oral Total scores were significantly different only between the NSAD group and HCs, whereas Pharyngeal Total score was not significantly different among the groups. CONCLUSIONS Spinal pathology is commonly observed during VFSS and can contribute to dysphagia, resulting in worse swallowing-related outcomes when compared with HCs. Patients judged to have SAD tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.
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Affiliation(s)
- Rameen K. Walters
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Rachana Gudipudi
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kate Davidson
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Melissa Cooke
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Jenna Barengo
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Drasti Smyre
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kendrea L. Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Department of Otolaryngology—Head and Neck Surgery and Radiation Oncology, Northwestern University, Evanston, IL
| | - Maria G. Matheus
- Department of Radiology, Medical University of South Carolina, Charleston
| | - Shaun A. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K. O'Rourke
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
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Sakaki K, Sakai K, Arai Y, Torigoe I, Tomori M, Hirai T, Onuma H, Kobayashi Y, Okawa A, Yoshii T. Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification. J Clin Med 2023; 12:jcm12051774. [PMID: 36902561 PMCID: PMC10003155 DOI: 10.3390/jcm12051774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.
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Affiliation(s)
- Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
- Correspondence: ; Tel.: +81-3-5803-5678
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Tran DDT, Nguyen QB, Truong VT, Truong TD, Do QV, Vo DP. Surgical Intervention of Dysphagia Caused by Ossification of Anterior Longitudinal Ligament: A Case Report. Asian J Neurosurg 2022; 17:485-488. [PMCID: PMC9665975 DOI: 10.1055/s-0042-1757214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ossification of the anterior longitudinal ligament (OALL) in the cervical spine is a common entity but rarely causes dysphagia, dyspnea, and dysphonia. We report an OALL case which causes such symptoms. A 47-year-old female patient had a complaint of progressive difficulty swallowing for 2 months. A cervical X-ray and computerized tomography scan were taken afterward, which showed OALL at the C3–7 level. She then had esophageal endoscopy to rule out other dysphagia-related disorders. The patient underwent anterior osteotomy via anterior cervical approach with significant relief of dysphagia postoperatively. Surgical management in symptomatic OALL improves dysphagia and prevents its secondary complications.
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Affiliation(s)
- Duc Duy Tri Tran
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam,Department of Neurosurgery, Xuyen A Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Bao Nguyen
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Van Tri Truong
- Division of Orthopedics, Central Hospital of University of Montreal, University of Montreal, Montreal, Canada,Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh city, Vietnam,Address for correspondence Duc Duy Tri Tran, MD, MSc Department of Neurosurgery, Xuyen A hospitalHo Chi Minh City, 733000Vietnam
| | - Thai Duong Truong
- Department of Neurosurgery, Xuyen A Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Vinh Do
- Department of Neurosurgery, Xuyen A Hospital, Ho Chi Minh City, Vietnam
| | - Duc Phong Vo
- Department of Neurosurgery, Xuyen A Hospital, Ho Chi Minh City, Vietnam
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Li C, Luo W, Zhang H, Zhao J, Gu R. Case Report: Diffuse idiopathic skeletal hyperostosis with ossification of the posterior longitudinal ligament in the cervical spine: A rare case with dysphagia and neurological deficit and literature review. Front Surg 2022; 9:963399. [PMID: 36017519 PMCID: PMC9395964 DOI: 10.3389/fsurg.2022.963399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the calcification and ossification of ligaments and tendons. Progressive dysphagia caused by DISH-related anterior cervical osteophytes and deteriorating dysphagia caused by DISH combined with neurological dysfunction resulting from the posterior longitudinal ligament is rare. The initial diagnosis is misleading and patients often consult several specialists before spine surgeons. This study aims to provide a comprehensive review of the literature on this challenging pathological association. We also present a case illustration where a 53-year-old man presented with progressive dysphagia and foreign body sensation in the pharynx, accompanied by a neurological numbness defect in the right upper limb. Radiography and computed tomography confirmed the existence of osteophytes at the anterior edge of the C4–C7 pyramid and ossification of the posterior longitudinal ligament, in which the giant coracoid osteophyte could be seen at the anterior edge of the C4–C5 pyramid. The anterior cervical osteophyte was removed, and decompression and fusion were performed. The symptoms were relieved postoperatively. No recurrence of symptoms was found during the six-month follow-up. Spine surgeons should consider progressive dysphagia caused by DISH-related osteophytes at the anterior edge of the cervical spine as it is easily misdiagnosed and often missed on the first evaluation. When combined with ossification of the posterior longitudinal ligament, following cervical osteophyte resection it is necessary to consider stabilizing the corresponding segments via fusion.
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Affiliation(s)
| | | | | | | | - Rui Gu
- Correspondence: Jianhui Zhao Rui Gu
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Seo M, Park JW. Head rotation as an effective compensatory technique for dysphagia caused by unilateral cervical osteophytes. J Int Med Res 2022; 50:3000605221116757. [PMID: 36036241 PMCID: PMC9434682 DOI: 10.1177/03000605221116757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Dysphagia is common in patients with cervical osteophytes. We aimed to
determine whether head rotation as a compensatory technique is effective for
dysphagia caused by unilateral cervical osteophytes. Methods We retrospectively analyzed videofluoroscopic swallowing study (VFSS) data
obtained in one university hospital. Patients whose VFSS showed pharyngeal
stasis by mechanical obstruction due to cervical osteophytes were selected.
They were divided into a unilateral skewed osteophyte group and a diffuse
central osteophyte group as confirmed by laryngoscopy or computed
tomography. The effect of head rotation on swallowing was investigated.
Fisher’s exact test was used for statistical analysis. Results Among 2876 patients who underwent VFSSs, we identified 48 patients with
osteophyte-induced dysphagia. The osteophytes were centrally located in 36
patients and unilateral in the remaining 12. Ten of the patients with
unilateral osteophytes showed improvement when they swallowed with head
rotation toward the osteophyte side, but none of the patients with central
osteophytes showed effective swallowing. A statistically significant
relationship was found between swallowing with head rotation and skewed
cervical osteophytes. Conclusion Swallowing with head rotation was safe, easy, and effective for patients with
dysphagia caused by unilateral cervical osteophytes. We advise attempting
this method prior to considering surgical approaches.
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Affiliation(s)
- Minsu Seo
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
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7
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Surgical Treatment of Dysphagia Secondary to Anterior Cervical Osteophytes Due to Diffuse Idiopathic Skeletal Hyperostosis. Medicina (B Aires) 2022; 58:medicina58070928. [PMID: 35888647 PMCID: PMC9321449 DOI: 10.3390/medicina58070928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is an ossifying and ankylosing skeletal condition that can be associated with DISH-related dysphagia in the case of cervical involvement. In contrast to most cases of dysphagia, which are managed conservatively, DISH-related dysphagia can be discouraging due to the progressive nature of DISH. We report two cases of DISH-related dysphagia that were treated with the surgical removal of osteophytes via an anterolateral approach. We were able to remove osteophytes using the bottleneck point as an anatomical landmark between the vertebral body and the bony excrescence. Patients’ symptoms improved following osteophyte removal, without recurrence. In cases of DISH-related dysphagia, osteophyte removal using an osteotome could improve dysphagia safely and quickly.
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8
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Geneva-Popova M, Hodzhev V, Popova-Belova S. Prognostic models for the development of diffuse idiopathic skeletal hyperostosis. Folia Med (Plovdiv) 2022; 64:450-458. [PMID: 35856107 DOI: 10.3897/folmed.64.e65233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Diffuse idiopathic skeletal hyperostosis (DISH) is a common worldwide disease in adults over 50 years of age. The clinical diagnosis at the beginning of the disease is very difficult, even impossible, without typical symptoms and image changes. Mathematical models for searching risk factors include analysing medical history data, comorbidities, biochemical and instrumental results.
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Hines K, Elmer N, Detweiler M, Fatema U, Gonzalez GA, Montenegro TS, Franco D, Prasad S, Jallo J, Sharan A, Heller J, Boon M, Spiegel J, Harrop J. Combined Anterior Osteophytectomy and Cricopharyngeal Myotomy for Treatment of DISH-Associated Dysphagia. Global Spine J 2022; 12:877-882. [PMID: 33203249 PMCID: PMC9344495 DOI: 10.1177/2192568220967358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective observational case series. OBJECTIVE To assess the outcome of patients with diffuse idiopathic skeletal hyperostosis (DISH) with dysphagia who underwent cricopharyngeal myotomy (CPM) in conjunction with anterior osteophytectomy (OP). METHODS This is a retrospective observational study of 9 patients that received combined intervention by neurosurgeons and otolaryngologists. Inclusion criteria for surgery consisted of patients who failed to respond to conservative treatments for dysphagia and had evidence of both upper esophageal dysfunction and osteophyte compression. We present the largest series in literature to date including patients undergoing combined OP and CPM. RESULTS A total of 88.9% (8/9) of the patients who underwent OP and CPM showed improvement in their symptoms. Of the aforementioned group, 22.2% of these patients had complete resolution of their symptoms, 11.1% did not improve, and only 2 patients showed recurrence of their symptoms. None of the patients in whom surgery was performed required reoperation or suffered serious complication related to the surgical procedures. CONCLUSION Based on the literature results, high rate of improvements in dysphagia, and low rate of complications, combined OP and CPM procedures may be beneficial to a carefully selected group of patients.
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Affiliation(s)
- Kevin Hines
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Nicholas Elmer
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Maxwell Detweiler
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Umma Fatema
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Glenn A. Gonzalez
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Thiago S. Montenegro
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Daniel Franco
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Srinivas Prasad
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Jack Jallo
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Ashwini Sharan
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Joshua Heller
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA
| | - Maurits Boon
- Thomas Jefferson University,
Philadelphia, PA, USA
| | | | - James Harrop
- Thomas Jefferson University,
Philadelphia, PA, USA,Jefferson Hospital for Neuroscience,
Philadelphia, PA, USA,James Harrop, Division of Spine and
Peripheral Nerve Surgery, Department of Neurological Surgery, Thomas Jefferson
University Hospital, 901 Walnut Street 3rd Floor, Philadelphia, PA 19107, USA.
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10
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Sul JH, Yang J, Kim TW. Intraoperative Traction May Induce Acute Onset Dysphagia With Diffuse Idiopathic Skeletal Hyperostosis After Anterior Cervical Discectomy. Korean J Neurotrauma 2022; 18:126-131. [PMID: 35557636 PMCID: PMC9064748 DOI: 10.13004/kjnt.2022.18.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jung Hoon Sul
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Joochul Yang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Bunmaprasert T, Keeratiruangrong J, Sugandhavesa N, Riew KD, Liawrungrueang W. Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review). J Orthop Surg (Hong Kong) 2021; 29:23094990211041783. [PMID: 34592856 DOI: 10.1177/23094990211041783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms "Anterior Cervical Osteophyte," "Diffuse Idiopathic Skeletal Hyperostosis (DISH)," and "Dysphagia" and "Treatment" for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated with DISH in elderly patients (average 65 years). The major clinical findings were dysphagia or respiratory compromise, with the most common level of bridging osteophytes of the cervical spine at C3-C5. There were 10 articles on surgical treatment involving anterior cervical osteophytectomy without fusion, 1 for multilevel cervical oblique corpectomy, 1 for anterior cervical discectomy with fusion plus plate, and 1 for anterior cervical osteophytectomy with stand-alone PEEK cage or plus plate. All the cases resulted in significant improvement without recurrence, with only 1 case having post-operative complications. Follow-up duration was 3-70.3 months. Conclusions: Surgical intervention for anterior cervical osteophytectomy appears to result in improved outcomes. However, there could be disadvantages concerning cervical spine motion if cervical osteophytectomy with cervical discectomy and fusion (ACDF) plus plate system is done.
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Affiliation(s)
- Torphong Bunmaprasert
- Department of Orthopaedics, Faculty of Medicine, 37686Chiang Mai University, Chiang Mai, Thailand
| | - Jakkrit Keeratiruangrong
- Department of Orthopaedics, Faculty of Medicine, 37686Chiang Mai University, Chiang Mai, Thailand
| | - Nantawit Sugandhavesa
- Department of Orthopaedics, Faculty of Medicine, 37686Chiang Mai University, Chiang Mai, Thailand
| | - K Daniel Riew
- Department of Neurological Surgery, The Och Spine Hospital at New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea.
Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed.
Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.
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13
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Park BJ, Gold CJ, Piscopo A, Schwickerath L, Bathla G, Chieng LO, Yamaguchi S, Hitchon PW. Outcomes and complications of surgical treatment of anterior osteophytes causing dysphagia: Single center experience. Clin Neurol Neurosurg 2021; 207:106814. [PMID: 34303287 DOI: 10.1016/j.clineuro.2021.106814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To better understand the functional swallow outcomes, cervical balance, and surgical complications, we examined patients with anterior osteophytes and dysphagia who were treated operatively. SUMMARY OF BACKGROUND DATA Anterior osteophytes from diffuse idiopathic skeletal hyperostosis (DISH) or degenerative etiology of the cervical spine can cause dysphagia from mechanical compression of the esophagus. Osteophytectomy is generally accepted as a safe surgical treatment, but the risk of instability is unclear. The potential for associated complications must be considered. METHODS Patients who had anterior osteophytes and dysphagia from 2005 to 2020 were reviewed retrospectively. Demographics, radiographic parameters, functional swallow outcome, and complications were examined. RESULTS There were 15 patients identified treated surgically. Increased osteophyte height positively correlated with severity of dysphagia with Pearson coefficient of 0.53 (p = 0.042). Functional Outcome Swallowing Scale (FOSS) scores improved after surgical treatment from median of 2 to 0 (p = 0.002). C2-7 SVA did increase by 8 mm (p = 0.007) but was generally well tolerated. There was a 27% complication rate including a case of C5 lateral mass fracture with central cord syndrome after a fall 4 days following osteophytectomy. There was one patient who was preoperatively dependent on gastrostomy tube who required a tracheostomy and had continued reliance on the gastrostomy tube. CONCLUSION Surgical treatment of anterior osteophytes causing dysphagia with osteophytectomy can lead to overall improved FOSS scores for most patients. However, a high preoperative FOSS score may be a prognostic indicator of poor postoperative functional swallow outcome. It is important to consider the potential for instability when osteophytectomy is performed at 3 or more spinal segments.
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Affiliation(s)
- Brian J Park
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Colin J Gold
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Anthony Piscopo
- Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA
| | - Laura Schwickerath
- Department of Otolaryngology, Univeristy of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Lee-Onn Chieng
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Gendreau JL, Sheaffer K, Bennett J, Abraham M, Patel NV, Herschman Y, Ruh N, Lindley JG. Timing of Surgical Intervention for Dysphagia in Patients With Diffuse Idiopathic Skeletal Hyperostosis: A Systematic Review and Meta-Analysis. Clin Spine Surg 2021; 34:220-227. [PMID: 33239502 DOI: 10.1097/bsd.0000000000001105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis. OBJECTIVE The objective was (1) to measure rates of successful resolution of dysphagia in patients after undergoing surgical intervention for diffuse idiopathic skeletal hyperostosis (DISH); and (2) to determine if older age, longer duration of preoperative symptoms, or increased severity of disease was correlated with unsuccessful surgical intervention. SUMMARY OF BACKGROUND DATA DISH, also known as Forestier disease, is an enthesopathy affecting up to 35% of the elderly population. Many patients develop osteophytes of the anterior cervical spine, which contribute to chronic symptoms of dysphagia causing debilitating weight loss and possibly resulting in the placement of a permanent gastrostomy feeding tube. For patients that fail conservative medical management, an increase in surgical interventions have been reported in the literature in the last 2 decades. MATERIALS AND METHODS A systematic search was performed on PubMed, Medline, Cochrane Library, and Embase. Studies measuring outcomes after surgical intervention for patients with dysphagia from DISH were selected for inclusion. Two independent reviewers screened and assessed all literature in accordance with Cochrane systematic reviewing standards. RESULTS In total, 22 studies reporting 119 patients were selected for inclusion. Successful relief of dysphagia was obtained in 89% of patients after surgical intervention. Failure to relieve dysphagia was associated with increased length of symptoms preoperatively (P<0.01) using logistic regression. Patients with more severe preoperative symptoms also seem to have an increased risk for treatment failure (risk ratio, 2.86; 95% confidence interval, 1.19-6.85; P=0.02). Treatment failure was not associated with patient age, use of intraoperative tracheostomy, implementation of additional fusion procedures, level of involved segments, or number of involved segments. CONCLUSIONS Patients undergoing surgical intervention have a higher likelihood of failing surgery with increasing preoperative symptom length and increased preoperative symptom severity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | - Mickey Abraham
- Department of Neurosurgery, University of California San Diego, San Diego, CA
| | - Nitesh V Patel
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Yehuda Herschman
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Nikki Ruh
- Walter Reed National Military Medical Center, Bethesda, MD
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15
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Gao K, Cao Y, Liu W, Sun S, Wu Y, Yu W. Anterior cervical surgery to treat diffuse idiopathic skeletal hypertrophic combined with cervical disc herniation: A case report. Medicine (Baltimore) 2021; 100:e26097. [PMID: 34087855 PMCID: PMC8183831 DOI: 10.1097/md.0000000000026097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by calcification of anterolateral ligaments of the spine and the rest of the body. DISH combined with disc herniation induces complex symptoms and is more difficult to treat. Here, we describe a complicated case of a patient diagnosed with DISH as well as cervical disc herniation that was successfully treated using anterior cervical surgery. PATIENTS CONCERN A 69-year-old Asian male experienced dysphagia and weakness in his left limbs. He also experienced a stiff neck and right slant over a 6-month period. DIAGNOSIS An X-ray revealed calcification of the C4-7 vertebral front edge and a narrowed intervertebral space between C5/6. Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) both showed compression of the spinal cord at the cervical 5/6. Esophagography revealed that osteophytes in the anterior margin of vertebral body (C4-C7) oppressed the esophagus. INTERVENTIONS An operation focused on anterior cervical C5/6 disc fusion and anterior vertebral C4-7 osteophyte removal was performed. OUTCOMES After the operation, X-ray and CT showed that most osteophytes were removed and spinal cord compression was relieved. One day following the operation, both dysphagia and numbness in limbs were improved. Strong recovery was observed at the three-month follow-up exam. LESSONS This complex DISH combined with disc herniation case is rarely observed in patients. Anterior cervical disc fusion and anterior vertebral osteophyte removal were effective treatment measures. This case study provides insight into treating cases presented with cervical spine complications associated with DISH combined with other ailments.
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16
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Kolz JM, Alvi MA, Bhatti AR, Tomov MN, Bydon M, Sebastian AS, Elder BD, Nassr AN, Fogelson JL, Currier BL, Freedman BA. Anterior Cervical Osteophyte Resection for Treatment of Dysphagia. Global Spine J 2021; 11:488-499. [PMID: 32779946 PMCID: PMC8119911 DOI: 10.1177/2192568220912706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVES When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. METHODS Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). RESULTS Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia (P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications (P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. CONCLUSIONS Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
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Affiliation(s)
- Joshua M. Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Atiq R. Bhatti
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marko N. Tomov
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brett A. Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Brett A. Freedman, Department of Orthopedic
Surgery, Mayo Clinic Minnesota, 200 First St SW, Rochester, MN 55905, USA.
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17
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Maiuri F, Cavallo LM, Corvino S, Teodonno G, Mariniello G. Anterior cervical osteophytes causing dysphagia: Choice of the approach and surgical problems. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 11:300-309. [PMID: 33824560 PMCID: PMC8019107 DOI: 10.4103/jcvjs.jcvjs_147_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Anterior cervical osteophytes (ACOs) may rarely cause dysphagia, dysphonia, and dyspnea. Symptomatic ACOs are most commonly located between C3 and C7, whereas those at higher cervical (C1-C2) levels are rarer. We report a case series of 4 patients and discuss the best surgical approach according to the ostheophyte location and size, mainly for those located at C1-C2, and the related surgical problems. Materials and Methods Four patients (two males and two females) aged from 57 to 72 years were operated on for ACOs, causing variable dysphagia (and dyspnea with respiratory arrest in one). Three patients with osteophytes between C3 and C5 were approached through antero-lateral cervical approach, and one with a large osteophyte between C1 and C3-C4 level underwent a two-stage transcervical and transoral approach. All had significant postoperative improvement of dysphagia. Results The patient operated on though the transoral approach experienced postoperative flogosis of the prevertebral tissues and occipital muscles and thrombosis of the right jugular vein and transverse-sigmoid sinuses (Lemierre syndrome). Conclusion The transoral approach is the best surgical route to resect C1 and C2 ACOs, whereas the endoscopic endonasal approach is not indicated. The anterior transcervical approach is easier to resect osteophytes at C3, as well as those located below C3. A combined transoral and anterior cervical approach may be necessary for multilevel osteophytes.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Giuseppe Teodonno
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
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18
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Lee JH, Paeng SH, Pyo SY, Kim ST, Lee WH. Swallowing Difficulty in Diffuse Idiopathic Skeletal Hyperostosis with Metabolic Syndrome. Korean J Neurotrauma 2020; 16:90-98. [PMID: 32395457 PMCID: PMC7192806 DOI: 10.13004/kjnt.2020.16.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 11/15/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a disease of unknown etiology developing following ossification of the antero-lateral ligaments of the spine. Mostly, prevailing elderly adult males, it is an uncommon cause of dysphagia and dysphonia. We report three cases of DISH with metabolic syndrome. They were complained of neck movement restriction and dysphagia. At first, They all visited ear, nose, and throat outpatient department. The initial impression was gastroesophageal reflux, and an endoscopy excluded esophageal lesion. Cervical spine radiologic imaging revealed ossification of the cervical anterior longitudinal ligament with large, conspicuous osteophytes from cervical spine lesion, producing compression of pharyngoesophagus and upper airway; these images corresponded to DISH. Cervical osteophyte surgical removal resulted in a complete alleviation from dysphagia for the patient. DISH should be considered in the differential diagnosis of dysphagia.
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Affiliation(s)
- Jin Ho Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Se Young Pyo
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Won Hee Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
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19
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Mattioli F, Ghirelli M, Trebbi M, Silvestri M, Presutti L, Fermi M. Improvement of Swallowing Function After Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis: Our Experience. World Neurosurg 2019; 134:e29-e36. [PMID: 31470164 DOI: 10.1016/j.wneu.2019.08.124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the swallowing improvement in patients who underwent a transcervical prevascular retrovisceral approach for symptomatic cervical diffuse idiopathic skeletal hyperostosis (DISH), by means of the 10-item Eating Assessment Tool (EAT-10) questionnaire. METHODS Retrospective observational study of 21 patients treated with a transcervical anterior prevascular retrovisceral approach for symptomatic DISH with dysphagia as the primary symptom. All patients underwent videofluoroscopic study of swallowing before surgery and the EAT-10 questionnaire before and after the surgical procedure. RESULTS A statistically significant (P < 0.001) improvement in the postoperative EAT-10 score was reported. Sixteen out of 21 patients (76.2%) had their symptoms completely resolved, with an EAT-10 score less than 3. These results were not influenced by age and sex nor by presence of tracheostomy. The preoperative EAT-10 score was consistently related to postoperative outcome. Patients with mild and moderate dysphagia had better Δ in EAT-10 scores than patients with severe and very severe dysphagia (P = 0.02). CONCLUSIONS Surgical management seems to be effective in resolving swallowing disorders related to this disease in a consistent percentage of patients. This evidence is supported by the statistically significant improvement in EAT-10 scores after treatment. Moreover, it might be postulated that early intervention can guarantee a higher success rate because patients with severe and very severe dysphagia had significantly smaller improvement.
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Affiliation(s)
- Francesco Mattioli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Michael Ghirelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy.
| | - Marco Trebbi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Martina Silvestri
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Matteo Fermi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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20
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Scholz C, Naseri Y, Hohenhaus M, Hubbe U, Klingler JH. Long-term results after surgical treatment of diffuse idiopathic skeletal hyperostosis (DISH) causing dysphagia. J Clin Neurosci 2019; 67:151-155. [PMID: 31221580 DOI: 10.1016/j.jocn.2019.05.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/28/2019] [Indexed: 01/30/2023]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory, systemic skeletal disease. The associated formation of anterior cervical osteophytes can cause severe dysphagia, so the osteophytes have to be surgically removed. Because the clinical syndrome is rare, long-term outcome after surgical therapy is likewise scarce. In this retrospective, single-center study, five consecutive patients with DISH causing dysphagia and following resection of osteophytes between 2005 and 2015 were included. Patient and surgical reports were evaluated regarding surgery-related and postoperative complications. For the short term, the outpatient visits three months and one year after the surgery were evaluated. For the long-term results, patients were followed via questionnaires concerning actual complaints, complications or further treatment associated to DISH. Five male patients (61.6 years old; range, 43-77) were operated. One patient had a transitory worsening of a preexisting hoarseness and one patient had permanent problems with singing postoperatively. All patients reported improvement of dysphagia after three months. One patient deceased five years after surgery independently of DISH without complaining about recurring dysphagia. After a mean follow-up of 70.3 months (range, 24-126 months), dysphagia was consistently improved in all remaining four patients. The patient with the slightest improvement and clinical deterioration in the course had an initially incomplete resection of osteophytes. Imaging showed a re-increase of ossifications 2.5 years after the surgery. Resection of symptomatic anterior osteophytes in DISH is a safe and promising procedure to improve dysphagia in the long-term, but the recurrence of osteophytes is possible years after initial treatment.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany.
| | - Yashar Naseri
- Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
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21
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Butler AJ, Ghasem A, Al Maaieh M. Dysphagia following lumbar spine surgery in the setting of undiagnosed DISH of the cervical spine: a case report. AME Case Rep 2019; 3:13. [PMID: 31231714 DOI: 10.21037/acr.2019.05.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/28/2019] [Indexed: 11/06/2022]
Abstract
Dysphagia is an often multifactorial pathology affecting many elderly patients. In addition to global neuromuscular change with normal aging, one component of its etiology may be direct compression of the pharynx or esophagus from overgrown bone from the anterior cervical spine. Diffuse idiopathic skeletal hyperostosis (DISH) is one condition that may contribute to this phenomenon. Of relatively high incidence (2.5% to 33.3%) in elderly populations, DISH has been described in the cervical spine though more frequently affects other spinal regions. The clinical case of an elderly man who developed significant dysphagia after undergoing lumbar spine surgery for spinal stenosis caused by DISH is presented. Awareness of the involvement in his cervical spine before surgery would likely have enabled a more prompt diagnosis of the etiology of dysphagia and allowed for peri-operative optimization of swallowing function to reduce morbidity. We recommend routine preoperative imaging of the cervical spine in all patients with a diagnosis of DISH to stratify risk for development of postoperative dysphagia.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Alexander Ghasem
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Motasem Al Maaieh
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
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22
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Abstract
STUDY DESIGN Retrospective case control study. OBJECTIVE To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH). SUMMARY OF BACKGROUND DATA DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown. METHODS We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O-C2 angle, M-C angle, C2-7 angle, and C2-6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre- and postoperative values in the S group. RESULTS The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22-27]) compared with the NS group (1 [1-6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0-1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2-7 and ΔC2-6a, and between pre- and postoperative values in the S group. There were no significant changes in O-C2 angle and M-C angle, which are parameters of the superior cervical vertebrae. CONCLUSION The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH. LEVEL OF EVIDENCE 4.
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23
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Choi HE, Jo GY, Kim WJ, Do HK, Kwon JK, Park SH. Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte. Ann Rehabil Med 2019; 43:27-37. [PMID: 30852868 PMCID: PMC6409658 DOI: 10.5535/arm.2019.43.1.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/14/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate swallowing characteristics of patients with dysphagia caused by anterior cervical osteophytes (ACOs) and compare clinical courses according to treatment options. METHODS A retrospective analysis of 1,866 videofluoroscopic swallowing studies (VFSS) of patients with ACOs from electronic medical records was performed. Patients with other diseases that could explain the dysphagia were excluded. Dysphagia characteristics and severity and clinical and radiological characteristics of subjects with ACOs were evaluated. Dysphagia characteristics and clinical course were compared among three treatment groups: surgical treatment, swallowing rehabilitation, and conservative treatment. RESULTS Subjects were 22 men and 1 woman with a mean age of 78.69±8.01 years. The mean osteophyte thickness was 9.07±3.84 mm. It was significantly thicker in the surgical group than that in other groups (p=0.01). ACOs were most frequently found at C5 level. This level also had the thickest osteophytes. However, videofluoroscopic dysphagia scales (VDS) were not significantly different among the three treatment groups. The pharyngeal phase score of the VDS was significantly higher in the surgical group (p=0.041). Dysphagia severity was decreased significantly in the surgical group at 3 months after the initial VFSS (p=0.004). CONCLUSION The main swallowing characteristics in patients with ACOs were dysphagia features of the pharyngeal phase, including inappropriate airway protection, decreased laryngeal elevation, and reduced epiglottis inversion. When determining treatment options, it may be helpful to consider dysphagia severity at pharyngeal phase and osteophyte thickness.
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Affiliation(s)
- Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Geun Yeol Jo
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Jin Kim
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hwan Kwon Do
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jun Koo Kwon
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Heum Park
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Mori K, Yayama T, Nishizawa K, Nakamura A, Mimura T, Imai S. Aortic pulsation prevents the development of ossification of anterior longitudinal ligament toward the aorta in patients with diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: Results of chest CT-based cross-sectional study. J Orthop Sci 2019; 24:30-34. [PMID: 30232028 DOI: 10.1016/j.jos.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/07/2018] [Accepted: 08/15/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The development and etiology of diffuse idiopathic skeletal hyperostosis (DISH) were far from complete understanding. Even the precise mechanism of the development of its typical right-sided ossification of the anterior longitudinal ligament (OALL) frequently compared to 'flowing candle wax', a hallmark of DISH, remains unknown. METHODS The participants of this study were 261 individuals (31 females and 230 males) diagnosed as DISH according to the criteria established by Resnick and Niwayama extracted from a consecutive 3013 patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years old were excluded. Chest CT data were converted to the condition suitable for bone evaluation by the software application. The positional relationship between thoracic aorta and OALL, the morphology of the OALL adjacent to the aorta and the presence of calcification of the aortic wall adjacent to the OALL were studied. RESULTS Of 261 individuals with DISH, we found that thoracic aorta was localized adjacent to the OALL (AD-group) in 123 cases (47%), whereas 138 cases (53%) were not (NAD-group). All OALL in AD-group was localized between T6 and T12. The shape of the OALL adjacent to the aorta was either flat or concave except for one. No case showed obvious calcification of the aortic wall adjacent to the OALL in AD-group. CONCLUSIONS The aortic pulsation might play an important role in inhibit the development of the OALL toward the aorta in DISH. It is likely that establishment of the optimal condition of the pulsation stress simulating aortic pulsation and its delivery system can achieve arresting, slowing the progression and/or changing the morphology of the ossified lesions.
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Affiliation(s)
- Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.
| | - Takafumi Yayama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Kazuya Nishizawa
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Akira Nakamura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Tomohiro Mimura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
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Neck pain and dysphagia secondary to diffuse idiopathic skeletal hyperostosis of the cervical spine: A case report. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.467092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shimizu M, Kobayashi T, Jimbo S, Senoo I, Ito H. Clinical evaluation of surgery for osteophyte-associated dysphagia using the functional outcome swallowing scale. PLoS One 2018; 13:e0201559. [PMID: 30067834 PMCID: PMC6070280 DOI: 10.1371/journal.pone.0201559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the surgical outcome of patients with osteophyte-associated dysphagia (OAD) using the functional outcome swallowing scale (FOSS). Methods A retrospective chart review of 10 surgical cases of OAD (9 male and 1 female patient; mean age of 65 years) from 1982 to 2017 was performed, and radiographic evaluations were conducted by video fluoroscopic swallow study (VFSS) and conventional radiography. All OAD cases were treated at a single institution, and osteophytes were surgically resected by the anterior approach under gentle retraction of the affected esophagus. FOSS (0 for normal, 5 for worst) was used for clinical evaluations, and surgical complications were recorded. Results VFSS evaluation of OAD showed that the affected osteophyte was located at C4/5 in four patients, followed by C3/4 in three patients. The mean FOSS showed significant improvement from 2.5 preoperatively to 0.3 postoperatively, and no major surgical complications were recorded. Comorbidities were diabetes mellitus in four patients, ossification of the posterior longitudinal ligament in three patients, and lumbar spinal stenosis (LSS) in three patients. Conclusion Surgical treatment of OAD was promising, and all patients showed clinical recovery. Evaluation of dysphagia using FOSS was easy and reliable for OAD management, and FOSS 2 might be a good indication for surgical intervention.
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Affiliation(s)
- Mutsuya Shimizu
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tetsuya Kobayashi
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Shizuo Jimbo
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Issei Senoo
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Psychogios G, Jering M, Zenk J. Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management. Front Surg 2018; 5:33. [PMID: 29740589 PMCID: PMC5928235 DOI: 10.3389/fsurg.2018.00033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/09/2018] [Indexed: 12/21/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary. In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2-C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed. Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea.
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Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Augsburg, Augsburg, Germany
| | - Monika Jering
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Augsburg, Augsburg, Germany
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Pyogenic Spondylitis Caused by Methicillin-Resistant Staphylococcus aureus Associated with Tracheostomy followed by Resection of Ossification of the Anterior Longitudinal Ligament. Case Rep Orthop 2018; 2018:9076509. [PMID: 29670792 PMCID: PMC5835278 DOI: 10.1155/2018/9076509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/17/2018] [Indexed: 11/20/2022] Open
Abstract
Symptomatic ossification of the anterior longitudinal ligament (OALL) is rare. However, when the osteophyte enlarges and obstructive symptoms occur, the patient may require surgery. We present a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus associated with tracheostomy followed by resection of OALL. A 69-year-old woman with OALL complained of dysphagia and suffocation, which was caused by prominent OALL at C4-5. Tracheostomy was performed, followed by osteophytectomy 6 weeks later. Two months after osteophytectomy, she complained of muscle weakness of the extremities, neck pain, and elevated temperature. Magnetic resonance imaging showed an intensity change at the C4-5 vertebrae and an epidural abscess that was causing cord compression requiring urgent decompression. Cultures identified methicillin-resistant Staphylococcus aureus. As osteolytic change and muscle weakness gradually progressed, she underwent anterior and posterior reconstruction with an autograft and instrumentation. Bone union was confirmed at 1 year postoperatively with improvement in neurological status. OALL has potentially the risk of airway obstruction. Therefore, appropriate diagnosis and prompt osteophytectomy are needed in cases of a large prominent ossification that puts the patient at risk of suffocation. However, it is noted that osteophytectomy following urgent tracheostomy carries the possible risk of infection.
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Lui Jonathan Y, Sayal P, Prezerakos G, Russo V, Choi D, Casey A. The surgical management of dysphagia secondary to diffuse idiopathic skeletal hyperostosis. Clin Neurol Neurosurg 2018; 167:36-42. [DOI: 10.1016/j.clineuro.2018.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/29/2022]
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Sebaaly A, Boubez G, Sunna T, Wang Z, Alam E, Christopoulos A, Shedid D. Diffuse Idiopathic Hyperostosis Manifesting as Dysphagia and Bilateral Cord Paralysis: A Case Report and Literature Review. World Neurosurg 2018; 111:79-85. [DOI: 10.1016/j.wneu.2017.12.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022]
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Bakker JT, Kuperus JS, Kuijf HJ, Oner FC, de Jong PA, Verlaan JJ. Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine. PLoS One 2017; 12:e0188414. [PMID: 29155874 PMCID: PMC5695822 DOI: 10.1371/journal.pone.0188414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/06/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology of the newly formed bone in the cervical spine is different compared to the thoracic spine, possibly due to dissimilarities in local vascular anatomy. In this study the spatial relationship of the new bone with the arterial system, trachea and esophagus was analyzed and compared between subjects with and without DISH. METHODS Cervical computed tomography (CT) scans were obtained from five patients with dysphagia and DISH and ten control subjects. The location of the vertebral and carotid arteries, surface area of the hyperostosis and distance between the vertebral body and the trachea and esophagus was assessed in the axial view. RESULTS The surface area of the newly formed bone was located symmetrically anterior to the vertebral body. The ossifications were non-flowing in the sagittal view and no segmental vessels were observed. Substantial displacement of the trachea/esophagus was present in the group with DISH compared to the controls. CONCLUSIONS The hyperostosis at the cervical level was symmetrically distributed anterior to the vertebral bodies without a flowing pattern, in contrast to the asymmetrical flowing pattern typically found in the thoracic spine. The hypothesis that the vascular system acts as a natural barrier against new bone formation in DISH could be further supported with these findings. The significant ventral displacement of the trachea and esophagus may explain the mechanism of dysphagia and airway obstruction in DISH.
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Affiliation(s)
- Jessica T. Bakker
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonneke S. Kuperus
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F. Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male. Case Rep Med 2017; 2017:2567672. [PMID: 29062363 PMCID: PMC5618740 DOI: 10.1155/2017/2567672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/16/2017] [Indexed: 11/23/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is rarely symptomatic. However, it can present with dyspnea, hoarseness, dysphagia, and stridor. An 80-year-old chronic smoker male presented with 6-month history of sore throat and progressive dysphagia. Computed tomography of the neck revealed bulky anterior bridging syndesmophytes along the anterior aspect of the cervical spine and facet effusion involving four contiguous vertebrae consistent with DISH. Dysphagia secondary to DISH was diagnosed. Fiberoptic laryngoscopy showed bilateral vocal cord paralysis. Patient's airway became compromised requiring tracheostomy tube placement. After discussion of therapeutic options, patient agreed on a percutaneous endoscopic gastrostomy tube insertion for nutritional support. Osteophytectomy was left to be discussed further.
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Abstract
OPINION STATEMENT Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.
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Affiliation(s)
- Scott M Smukalla
- Department of Gastroenterology, Center for Esophageal Disease, NYU School of Medicine, 240 East 38th St., 23rd Floor, New York, NY, 10016, USA
| | - Irina Dimitrova
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Abraham Khan
- Department of Gastroenterology, Center for Esophageal Disease, NYU School of Medicine, 240 East 38th St., 23rd Floor, New York, NY, 10016, USA.
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Lee JJ, Hong JY, Jung JH, Yang JH, Sohn JY. Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte. Korean J Crit Care Med 2017; 32:74-78. [PMID: 31723619 PMCID: PMC6786737 DOI: 10.4266/kjccm.2016.00409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/26/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022] Open
Abstract
A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
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Affiliation(s)
- Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ji Young Hong
- Division of Pulmonology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jun Han Jung
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun Hyeok Yang
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Young Sohn
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
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Sugimura Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y. Histological evaluation of symptomatic ossification of the anterior longitudinal ligament treated with etidronate disodium: a case report. J Med Case Rep 2016; 10:320. [PMID: 27832809 PMCID: PMC5105241 DOI: 10.1186/s13256-016-1100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Here we report the first autopsied case involving pathological examination after two resections of symptomatic ossification of the anterior longitudinal ligament with anterior osteophytes and etidronate treatment with more than 8 years of follow-up. Case presentation A 51-year-old Japanese man complained of severe dysphagia due to esophageal compression by ossification of his anterior longitudinal ligament with anterior cervical osteophytes. Although surgical removal of the anterior cervical osteophytes was performed following etidronate treatment (800 mg/day for 6 months), dysphagia occurred secondary to recurrent ossification of his anterior longitudinal ligament with anterior osteophytes 7 years after the initial resection. A second resection of the anterior cervical osteophytes was performed, and cyclic administration of etidronate disodium (1000 mg/day, 3-month administration and 3-month cessation) did not result in re-outgrowth of ossification of his anterior longitudinal ligament with anterior osteophytes. At 1 year and 6 months after the second surgery, he suddenly died. The pathological findings associated with the ossification of his anterior longitudinal ligament during etidronate therapy showed no recurrence of ossification of the anterior longitudinal ligament with anterior osteophytes. Conclusion A recurrence of ossification of the anterior longitudinal ligament with anterior osteophytes formation, which caused dysphagia, was not observed with the cyclic administration of etidronate disodium at a dose of 1000 mg/day every 3 months for a period of 1 year and 5 months in the present case.
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Affiliation(s)
- Yusuke Sugimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Vodičar M, Košak R, Vengust R. Long-term Results of Surgical Treatment for Symptomatic Anterior Cervical Osteophytes: A Case Series With Review of the Literature. Clin Spine Surg 2016; 29:E482-E487. [PMID: 27755206 DOI: 10.1097/bsd.0b013e31829046af] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Presentation of a case series (10 patients) with surgical treatment of symptomatic anterior cervical osteophytes, a review of the latest literature and discussion of surgical methods. OBJECTIVE To present our results of the surgical treatment and compare them with the existing literature. On the basis of the gathered data, we aim to propose an optimal choice of surgical treatment. SUMMARY OF BACKGROUND DATA Anterior cervical osteophytes rarely cause symptoms that require surgical treatment, which disables bigger cohort analysis. Surgery always includes anterior osteophyte resection. Some authors propose instrumented anterior fusion after osteophyte resection as the first choice of surgery in order to prevent regrowth of osteophytes, whereas others support resection without fusion because of beneficial long-term results. METHODS Diagnostics included plain radiography, contrast esophagography, computed tomography and/or magnetic resonance imaging. Treatment consisted of left lateral cervicotomy and osteophytectomy. We performed a systematic review of the literature from 2006. RESULTS Average age at surgery was 69.5 years (63-77 y), average follow-up 61.9 months (15-117 mo). Twenty-five osteophytes were resected, with average size of 12.7 mm (4-22 mm) preoperatively and 5.12 mm (0-12 mm) at final follow-up. Average functional outcome swallowing scale score before surgery was 3.3 (2-5) and 1.2 (0-5) at final follow-up. Only 1 patient had reoccurrence of symptoms because of osseous etiology. CONCLUSIONS Symptomatic ventral cervical osteophytes can be successfully treated by surgery. In the majority of patients, osteophytes do not regrow significantly in the long term, precluding the need for prophylactic instrumented fusion after osteophyte resection.
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Affiliation(s)
- Miha Vodičar
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia, Europe
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Cervical Osteophytes Increase the Risk for Foreign Body Impaction: A 171-Patient Case–Control Study. Dysphagia 2016; 31:749-756. [DOI: 10.1007/s00455-016-9731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
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Moriwaki M, Hase H, Fujioka S, Yonekura N, Katao N, Takahashi K, Mori M, Koyama T, Domen K. Prolonged Dysphagia due to a Combination of Cerebral Hemorrhage and Diffuse Idiopathic Skeletal Hyperostosis: A Case Report. NMC Case Rep J 2016; 3:75-79. [PMID: 28664003 PMCID: PMC5386171 DOI: 10.2176/nmccrj.cr.2016-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/19/2016] [Indexed: 11/23/2022] Open
Abstract
A 79-year-old man was diagnosed with left thalamic hemorrhage. On admission, the Functional Independence Measure (FIM) motor score was 13 points, and the Food Intake Level Scale (FILS) was Level 2, with the patient needing enteral nutrition. Six months after stroke onset, the FIM motor score had improved to 38 points and the dysphagia to FILS Level 7. The patient was able to ingest easy-to-swallow food orally three times a day, but only after postural adjustment with rotation of the head. Seven months after stroke onset, the FIM motor score had reached 45 points but without further improvement in swallowing function. Videofluoroscopic swallowing evaluation (VF) revealed that the persistence of dysphagia was due to osteophytes on the cervical vertebrae caused by diffuse idiopathic skeletal hyperostosis. On surgical removal of the osteophytes, swallowing function improved to FILS Level 9; the patient was able to ingest normal food in a seated position without postural adjustment. One year after stroke onset, the patient was discharged with an FIM motor score of 59 points and FILS Level 9. At the 2-year follow-up, there was minimal recurrence of the osteophytes, and both motor and swallowing functions were maintained at the same level as at discharge. This case suggests that dysphagia in elderly patients may be due to multiple disorders, and that surgical intervention may occasionally be effective.
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Affiliation(s)
- Misa Moriwaki
- Department of Rehabilitation Medicine, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Hitoshi Hase
- Spine Center, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Seiji Fujioka
- Department of Rehabilitation Medicine, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Noriko Yonekura
- Department of Rehabilitation Medicine, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Naoko Katao
- Department of Rehabilitation Medicine, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Kazuhiro Takahashi
- Department of Neurosurgery, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Masaki Mori
- Spine Center, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, 663-8211 Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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The Efficiency of Zero-profile Implant in Anterior Cervical Discectomy Fusion: A Prospective Controlled Long-term Follow-up Study. ACTA ACUST UNITED AC 2016; 28:398-403. [PMID: 24136051 DOI: 10.1097/bsd.0000000000000032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A prospective controlled study. OBJECTIVE The aim of this study was to compare the safety and efficacy of the zero-profile device with that of an anterior cervical plate and cage in patients undergoing anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA A series of studies have indicated that anterior instruments produce good clinical results during ACDF. However, common implants are associated with a high rate of postoperative complications. A cervical stand-alone cage with integrated fixation for zero-profile segmental stabilization has been developed to solve this problem. MATERIALS AND METHODS A total of 46 patients with cervical radiculopathy or myelopathy were randomly treated with an anterior plate and a cage or a new zero-profile implant between September 2009 and April 2010. Patients were followed for 2 years. The operation time, blood loss, exposure to radiation, the Japan Department of Orthopedics Association (JOA) score, pain Visual Analogue Score (VAS), and dysphagia score were recorded. RESULTS The operation was completed successfully in 46 patients. Twenty-three patients received an anterior plate and cage (control group) and 23 patients received the new zero-profile implant (test group). Analysis of postoperative data at all protocol-defined intervals demonstrated improvement in all clinical outcomes for both the groups when compared with the corresponding preoperative data. No significant difference in VAS and JOA score was found in the 2 treatment groups. The test group had a greater reduction in dysphagia at all follow-up intervals, compared with the control group. No adjacent segment degeneration was found in the test group, whereas 4 patients in the control group developed degeneration in adjacent segments (P=0.045). Both the groups had no adverse events associated with the implant or implant surgery. CONCLUSIONS The Zero-P implant is a viable alternative to ACDF in patients with persistently symptomatic, single-level cervical disk disease. The procedure requires more technical requirements than traditional plates.
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Egerter AC, Kim ES, Lee DJ, Liu JJ, Cadena G, Panchal RR, Kim KD. Dysphagia Secondary to Anterior Osteophytes of the Cervical Spine. Global Spine J 2015; 5:e78-83. [PMID: 26430607 PMCID: PMC4577331 DOI: 10.1055/s-0035-1546954] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/16/2015] [Indexed: 10/26/2022] Open
Abstract
Study Design Retrospective case series. Objective Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease involves hyperostosis of the spinal column. Hyperostosis involving the anterior margin of the cervical vertebrae can cause dysphonia, dyspnea, and/or dysphagia. However, the natural history pertaining to the risk factors remain unknown. We present the surgical management of two cases of dysphagia secondary to cervical hyperostosis and discuss the etiology and management of DISH based on the literature review. Methods This is a retrospective review of two patients with DISH and anterior cervical osteophytes. We reviewed the preoperative and postoperative images and clinical history. Results Two patients underwent anterior cervical osteophytectomies due to severe dysphagia. At more than a year follow-up, both patients noted improvement in swallowing as well as their associated pain. Conclusion The surgical removal of cervical osteophytes can be highly successful in treating dysphagia if refractory to prolonged conservative therapy.
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Affiliation(s)
- Alexander C Egerter
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Eric S Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Darrin J Lee
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Jonathan J Liu
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Gilbert Cadena
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Ripul R Panchal
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
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Anterior Herniation of Partially Calcified and Degenerated Cervical Disc Causing Dysphagia. Asian Spine J 2015; 9:612-6. [PMID: 26240723 PMCID: PMC4522454 DOI: 10.4184/asj.2015.9.4.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/18/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of anterior cervical disc herniation associated with dysphagia. A 32-year-old man presented with complaints of dysphagia and concomitant pain in the right arm resistant to conservative therapy. On physical examination with respect to the muscle strength, the right shoulder abduction and flexion of the forearm were 3/5. Lateral X-ray revealed calcified osteophytes at the anterior C4-5 level. Magnetic resonance imaging showed soft disc herniation involving the right C6 root at the C5-6 level and anterior herniation of the C4-5 cervical disc. Anterior discectomies for C4-5 and C5-6 levels stabilized and ameliorated the dysphagia and pain. Cervical disc herniation usually presents with radicular findings. However, dysphagia may be an uncommon presentation. Anterior cervical disc herniation should be considered in a patient presenting with dysphagia.
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Murayama K, Inoue S, Tachibana T, Maruo K, Arizumi F, Tsuji S, Yoshiya S. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient. Medicine (Baltimore) 2015; 94:e1295. [PMID: 26266365 PMCID: PMC4616720 DOI: 10.1097/md.0000000000001295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Descriptive case report.To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one.Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown.A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5.We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications.We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery.
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Affiliation(s)
- Kazuhiro Murayama
- From the Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Chaudhary BR, Fehlings MG. Ankylosing Spinal Disorders—Falls, Flawed Flexibility, and Fixations. World Neurosurg 2015; 83:724-6. [DOI: 10.1016/j.wneu.2015.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
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Bertolino J, Scemama U, Jean E, Frances Y, Granel B. [A difficult swallowing]. Rev Med Interne 2015; 36:636-7. [PMID: 25908433 DOI: 10.1016/j.revmed.2015.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- J Bertolino
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille, France; Aix-Marseille université, 13005 Marseille, France
| | - U Scemama
- Aix-Marseille université, 13005 Marseille, France; Service d'imagerie médicale, hôpital Nord, 13915 Marseille, France
| | - E Jean
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille, France; Aix-Marseille université, 13005 Marseille, France
| | - Y Frances
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille, France; Aix-Marseille université, 13005 Marseille, France
| | - B Granel
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille, France; Aix-Marseille université, 13005 Marseille, France.
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Jeong H, Seo HG, Han TR, Chung CK, Oh BM. Kinematic changes in swallowing after surgical removal of anterior cervical osteophyte causing Dysphagia: a case series. Ann Rehabil Med 2014; 38:865-70. [PMID: 25566490 PMCID: PMC4280387 DOI: 10.5535/arm.2014.38.6.865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/16/2014] [Indexed: 11/06/2022] Open
Abstract
This retrospective case series included five patients who underwent surgical resection of the cervical anterior osteophyte due to dysphagia. Videofluoroscopic swallowing studies (VFSSs) were performed before and after surgery on each patient, and kinematic analysis of the video clips from the VFSS of a 5-mL liquid barium swallow was carried out. Functional oral intake improved after surgery in 3/4 patients who had required a modified diet before surgery. Kinematic analysis showed increases in the maximal hyoid vertical movement length (13.16±5.87 to 19.09±4.77 mm, p=0.080), hyoid movement velocities (170.24±84.71 to 285.53±104.55 mm/s, p=0.043), and upper esophageal sphincter opening width (3.97±0.42 to 6.39±1.32 mm, p=0.043) after surgery. In conclusion, improved upper esophageal sphincter opening via enhancement of hyoid movement after cervical anterior osteophyte resection may be the kinetic mechanism of improved swallowing function.
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Affiliation(s)
- Hyeonghui Jeong
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Agirman M, Durmus O, Ormeci T, Teker B, Cakar E. Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia in a young patient with metabolic syndrome. PM R 2014; 7:451-2. [PMID: 25460208 DOI: 10.1016/j.pmrj.2014.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Mehmet Agirman
- Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey(∗).
| | - Oguz Durmus
- Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey(†)
| | - Tugrul Ormeci
- Department of Radiology, Istanbul Medipol University, Istanbul, Turkey(‡)
| | - Bahri Teker
- Infectious Diseases and Clinical Microbiology, Nisa Hospital, Istanbul, Turkey(§)
| | - Engin Cakar
- Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey(¶)
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Hwang JS, Chough CK, Joo WI. Giant anterior cervical osteophyte leading to Dysphagia. KOREAN JOURNAL OF SPINE 2013; 10:200-2. [PMID: 24757489 PMCID: PMC3941753 DOI: 10.14245/kjs.2013.10.3.200] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/11/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022]
Abstract
Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.
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Affiliation(s)
- Jin Seop Hwang
- Department of Neurosurgery, Yeouido St. Mary's Hospital, Catholic University of Korea, Korea
| | - Chung Kee Chough
- Department of Neurosurgery, Yeouido St. Mary's Hospital, Catholic University of Korea, Korea
| | - Won Il Joo
- Department of Neurosurgery, Yeouido St. Mary's Hospital, Catholic University of Korea, Korea
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Zeng JH, Zhong ZM, Chen JT. Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors. Arch Orthop Trauma Surg 2013; 133:1067-71. [PMID: 23689648 DOI: 10.1007/s00402-013-1773-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND Dysphagia is a common complication of anterior cervical spine surgery, and most of them occurred in the early postoperative period. This study aimed to determine the incidence of early dysphagia after anterior cervical spine surgery and to identify its risk factors. METHODS A review of 186 consecutive patients undergoing anterior cervical spine surgeries in a 3-year period was performed. Dysphagia at postoperative 1 month was surveyed, and the severity of dysphagia was evaluated. Demographic information and procedural characters were collected to determine their relationships to dysphagia. RESULTS A total of 50 patients developed early postoperative dysphagia, including 23 males and 27 females. The incidence of early dysphagia after anterior cervical spine surgery was 26.9 % in this study. Mild, moderate, and severe dysphagia were found in 30, 14, and 6 patients, respectively. Female, advanced age, multi-levels surgery, use of plate, and a big protrusion of plate were found to be significantly increased early dysphagia after anterior cervical spine surgery. CONCLUSION There is a relatively high incidence of early dysphagia after anterior cervical spine surgery, which may be attributable to multiple factors.
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Affiliation(s)
- Ji-Huan Zeng
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
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Osteofitos cervicales: una causa rara de adelgazamiento. Rev Clin Esp 2012; 212:e33-5. [DOI: 10.1016/j.rce.2011.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/10/2011] [Indexed: 11/17/2022]
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Verlaan JJ, Boswijk PFE, de Ru JA, Dhert WJA, Oner FC. Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction. Spine J 2011; 11:1058-67. [PMID: 22015236 DOI: 10.1016/j.spinee.2011.09.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/07/2011] [Accepted: 09/07/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed condition relating to ossification of spinal ligaments that can cause compression of the esophagus and trachea. According to case reports, dysphagia or airway obstruction resulting from DISH is a rare occurrence. PURPOSE This study was intended to identify all published cases of dysphagia and/or airway obstruction resulting from DISH to increase the epidemiologic/clinical knowledge of these related conditions. STUDY DESIGN A systematic review of the literature was performed. METHODS The articles resulting from the systematic PubMed/EMBASE search of the literature were closely read, and predefined parameters were scored. RESULTS The search yielded a total of 118 articles (95 case reports and 23 case series) describing 204 patients with dysphagia and/or airway obstruction resulting from DISH. The number of cases demonstrated a steady increase from 1980 to 2009. This might be a real effect not ascribable to publication bias or expansion of the medical literature alone. CONCLUSIONS Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon. Diffuse idiopathic skeletal hyperostosis should be included in the differential diagnosis of dysphagia and airway obstruction.
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Affiliation(s)
- Jorrit-Jan Verlaan
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands.
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