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Lyrtzis C, Poutoglidis A, Stamati A, Lazaridis N, Paraskevas G. A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach. Cureus 2024; 16:e59011. [PMID: 38800226 PMCID: PMC11127740 DOI: 10.7759/cureus.59011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Dysphagia is a common symptom with various underlying etiologies, making its management challenging even for experienced physicians. The presence of osteophytes in the cervical spine may often impede swallowing, displace the larynx, and cause a sore throat. We describe a case of an 85-year-old male who presented with a two-year history of progressive dysphagia, exacerbated over the last two months, especially with solid foods and liquids, prompting an ENT evaluation. Despite prior investigations, including normal gastroscopy and empirical pain management, further assessment revealed bulging masses in the hypopharynx indicative of cervical osteophytes. Conservative management, including speech and swallow therapy, dietary modifications, and pharmacological interventions, resulted in significant symptom improvement without surgical intervention. This case demonstrates the effectiveness of conservative treatment measures in treating dysphagia caused by cervical osteophytes, emphasizing the significance of a multidisciplinary approach for optimal patient care.
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Affiliation(s)
- Christos Lyrtzis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Athina Stamati
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - George Paraskevas
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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2
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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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3
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Al-Jafari M, Abu Tapanjeh S, Al-Azzawi H, Abu Eid S, Baidoun HJ, Abu-Jeyyab M, Sarhan MY, Jbara H, Akel A. Cervical Spine Osteophyte: A Case Report of an Unusual Presentation. Cureus 2023; 15:e44762. [PMID: 37809146 PMCID: PMC10556974 DOI: 10.7759/cureus.44762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes abnormal bone growth at the sites of ligament insertion, mainly in the spine. It is of unknown etiology and usually affects older males. It is often asymptomatic, but it can sometimes cause dysphagia if it affects the anterior cervical spine. We report the case of a 50-year-old male patient with DISH who presented with chronic dysphagia and was diagnosed with a large cervical osteophyte compressing the esophagus. The patient had a history of several comorbidities, including diabetes, hypertension, stroke, and gout. He underwent surgical removal of the osteophyte and recovered well. We discuss the clinical features, diagnosis, and treatment options for this rare complication of DISH.
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Affiliation(s)
| | | | | | - Sura Abu Eid
- College of Medicine, Mutah University, Al-Karak, JOR
| | | | | | - Mohammed Y Sarhan
- Department of Orthopedic Surgery, Hashemite University, Al-Zarqaa, JOR
| | - Hiba Jbara
- Department of Neurosurgery, Al-Basheer Hospital, Amman, JOR
| | - Alaa Akel
- Department of Orthopedic Surgery, Mutah University, Al-Karak, JOR
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Keller J. [Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia]. DER NERVENARZT 2023; 94:702-707. [PMID: 36897376 DOI: 10.1007/s00115-023-01456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients. OBJECTIVE Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options. MATERIAL AND METHODS Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia. RESULTS The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization. CONCLUSION In some cases, symptomatic ventral cervical spondylophytes can be a relevant differential diagnosis of neurogenic dysphagia. For a more precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, a video fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, a resection of the bone spurs leads to a significant improvement or even to a complete restitution of the swallowing disorders.
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Affiliation(s)
- Jochen Keller
- St. Martinus-Krankenhaus Düsseldorf, Gladbacherstraße 26, 40219, Düsseldorf, Deutschland.
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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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Go YI, Kim GW, Won YH, Park SH, Ko MH, Seo JH, Kim DS. Aggravation of dysphagia after surgical removal of anterior cervical osteophytes: a case report. J Int Med Res 2022; 50:3000605221125098. [PMID: 36127824 PMCID: PMC9502249 DOI: 10.1177/03000605221125098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dysphagia induced by anterior cervical osteophytes (ACOs) is frequently reported in older individuals. Surgical resection of ACOs is considered when conservative treatment fails, but its effectiveness is controversial owing to side effects after surgery. We present the case of a 78-year-old man who complained of progressive dysphagia that started 10 months previously. A videofluoroscopic swallow study (VFSS) showed prominent ACOs along C2-C6, which translocated the upper hypopharynx anteriorly, impinging the lumen and impairing epiglottic folding and laryngeal closure. Aspiration of a soft diet was observed. Despite conservative therapy, the symptoms persisted, and ACO resection surgery was performed. Unexpectedly, the patient's dysphagia worsened immediately post-surgery. A VFSS on postoperative day (POD) 2 showed improvement in epiglottic folding. However, prevertebral soft tissue swelling and dysfunction of opening of the upper esophageal sphincter newly arose. Laryngeal aspiration was observed during 5 cc and a large amount of liquid swallowing trials. The patient was provided a modified diet and rehabilitative dysphagia therapy. A VFSS on PODs 6 and 14 showed a gradual improvement in the prevertebral soft tissue swelling. This report suggests that a serial VFSS is effective for evaluating the different mechanisms of dysphagia and for devising an appropriate treatment plan.
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Affiliation(s)
- Young-In Go
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yu-Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung-Hee Park
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Da-Sol Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Harlianto NI, Kuperus JS, Mohamed Hoesein FAA, de Jong PA, de Ru JA, Öner FC, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review. Spine J 2022; 22:1490-1503. [PMID: 35283294 DOI: 10.1016/j.spinee.2022.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine. PURPOSE Our previous systematic review on the epidemiological and clinical knowledge of dysphagia and airway obstruction caused by cervical DISH was updated, with a focus on (surgical) treatment and outcomes. STUDY DESIGN A systematic review of the literature was performed. METHODS Publications in Medline and EMBASE from July 2010 to June 2021 were searched. Two investigators performed data extraction and study specific quality assessment. RESULTS A total of 138 articles (112 case reports and 26 case series) were included, describing 419 patients with dysphagia and/or airway obstruction. The mean age of the patient group was 67.3 years (range: 35-91 years), and 85.4% was male. An evident increase of published cases was observed within the last decade. Surgical treatment was chosen for 66% of patients with the anterolateral approach most commonly used. The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. Improvement of dysphagia was observed in 95.5% of operated patients. After a mean follow-up of 3.7 years (range: 0.4-9.0 years), dysphagia recurred in 12 surgically treated patients (4%), of which five patients had osteophyte regrowth. CONCLUSIONS The number of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical DISH.
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Affiliation(s)
- Netanja I Harlianto
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Jonneke S Kuperus
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | | | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jacob A de Ru
- Department of Otolaryngology, Ministry of Defense, Central Military Hospital, Utrecht, The Netherlands
| | - F Cumhur Öner
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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8
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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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9
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Pongmanee S, Rojdumrongrattana B, Kritworakarn N, Sarasombath P, Liawrungrueang W. An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS). Int J Surg Case Rep 2022; 93:106993. [PMID: 35367943 PMCID: PMC8976121 DOI: 10.1016/j.ijscr.2022.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is a systemic condition characterized by calcification and ossification of ligaments and entheses which often mainly affects the thoracic spine. Anterior osteophyte compression of the esophagus resulting in dysphagia and dyspepsia is extremely rare in symptomatic thoracic DISH. Case presentation A 72-year-old male presented with dyspepsia and dysphagia for 10 months. A large beak-like anterior osteophyte, detected by a radiographic study and by a Barium esophagogram test at the T9-T10 level of the thoracic spine, was established by gastrointestinal medicine specialists to be the cause of the symptoms. The large anterior osteophyte was removed using video-assisted thoracoscopic surgery (VATS). At the one-year follow-up, the patient's symptoms had significantly improved and there was no recurrence of the osteophyte or the dyspepsia and dysphagia. Clinical discussion Thoracic DISH rarely presents with dysphagia and dyspepsia due to the greater mobility of the esophagus in the area of the thoracic spine than in the area of the cervical spine. This is the first reported case of symptomatic thoracic DISH treated by anterior thoracic osteophytectomy with VATS. The treatment was effective with no post-operative complications. Conclusion Anterior thoracic osteophytectomy with VATS is an effective surgical treatment option for this condition. Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is an extremely rare form of symptomatic thoracic DISH. Secondary dysphagia and dyspepsia can be caused by a giant beak-like anterior osteophyte at the T9-T10 levels of the thoracic spine. Surgical management with video-assisted thoracoscopic surgery (VATS) provides results superior to non-surgical treatments.
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10
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Aires MM, Fukumoto GM, Ribeiro SL, Haddad L, Alvarenga EHDL. Dysphagia due to anterior cervical osteophytosis: case report. Codas 2021; 34:e20200435. [PMID: 34932659 PMCID: PMC9927700 DOI: 10.1590/2317-1782/20212020435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
Anterior cervical osteophytosis is a noninflammatory condition characterized by calcification or ossification of the anterolateral paravertebral ligaments of the cervical spine. It affects 20 to 30% of the elderly, being responsible for 1.6% of the identifiable etiologies of dysphagia in the senile population. In advanced states, dysphagia due to cervical osteophytosis can lead to complications such as malnutrition, weight loss and aspiration pneumonia. This study aims to alert to this diagnosis, enabling early treatment of the condition. The case of a 66-year-old male patient with choking dysphagia for solids and nasal food reflux for 1 year is reported. Fiberoptic Endoscopic Evaluation of Swallowing showed bulging of the posterior pharyngeal wall and, with solid food supply, restriction to the retroflexion of the epiglottis, nasal reflux of the food and a large amount of food residue on the lesion. Cervical spine Computed Tomography identified the presence of anterior cervical osteophytes between the C3 and C6 vertebrae, the largest with anteroposterior length of 12 millimeters, narrowing the air column at the level of the oro- and hypopharynx. The patient was adequately treated with swallowing therapy by speech-language pathologist. The initial treatment strategy for symptomatic osteophytosis should be conservative, usually with a good response to swallowing therapy. Although they are rarely implicated in the etiology of dysphagia, considering its high prevalence, it is important that otolaryngologists and speech-language pathologists are attentive to this diagnosis, allowing early and effective treatment for the assisted patient, better prognosis and fewer complications of oropharyngeal dysphagia in the elderly.
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Affiliation(s)
- Mateus Morais Aires
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP – São Paulo (SP), Brasil.
| | - Gabriela Marie Fukumoto
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP – São Paulo (SP), Brasil.
| | - Sarah Lima Ribeiro
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo – USP – Ribeirão Preto (SP), Brasil.
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP – São Paulo (SP), Brasil.
| | - Eliézia Helena de Lima Alvarenga
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP – São Paulo (SP), Brasil.
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Liawrungrueang W, Sarasombath P, Maihom T, Tantivorawit W, Sugandhavesa N, Bunmaprasert T. Anterior cervical spine surgery for treatment of secondary dysphagia associated with cervical myelopathy in patient with Forestier's disease. Ann Med Surg (Lond) 2021; 72:103120. [PMID: 34888049 PMCID: PMC8637186 DOI: 10.1016/j.amsu.2021.103120] [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: 10/29/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance: Forestier's disease, also known as a vertebral ankylosing hyperostosis or Diffuse Idiopathic Skeletal Hyperostosis (DISH), is a non-inflammatory enthesopathy that affects primarily elderly males and ossifies the anterolateral spine while sparing the intervertebral discs and joint spaces, especially at the cervical spine. Forestier's disease has resulted in the growth of large anterior cervical osteophytes that may compress the pharyngoesophageal region, producing dysphagia. However, symptomatic Forestier's disease presenting with dysphagia and cervical myelopathy is rarely observed. Case presentation A 48-year-old male presented with progressive dysphagia and cervical myelopathy. Based on the presence of radiographic study, Forestier's disease was suspected. Large anterior cervical osteophytes at C4–C6 levels compressed the pharyngoesophageal structure posteriorly. Multilevel degenerative discs compressing the C4 to C6 spinal cord were also seen on sagittal MRI T2-weighted images. Anterior cervical osteophytectomy with anterior cervical discectomy and fusion (ACDF) were performed. The patient made a complete neurological recovery and had no recurrent symptoms at the 5-year follow-up. The patient was extremely satisfied with this treatment and can improved his quality of life (QOL). Clinical discussion Treatment of symptomatic Forestier's disease with secondary dysphagia and cervical myelopathy is rare evidenced by the dearth of reports on surgical treatment. Surgical intervention appears to be safe, effective, and able to halt disease progression. Conclusion Anterior cervical osteophytectomy combined with ACDF with plate fixation is a preferred technique in both neural decompression and swallowing improvement. Surgical intervention, we consider, provides superior results than prolonged non-surgical treatments. Forestier's disease or Diffuse Idiopathic Skeletal Hyperostosis (DISH) presenting with secondary dysphagia associated with cervical myelopathy is a rare condition treated by surgery. Anterior cervical osteophytectomy with simultaneous anterior cervical discectomy and fusion (ACDF) is a challenging surgical procedure for the patients in this condition. Surgical management provides superior result than non-surgical treatments.
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12
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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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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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Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia-Molecular and Clinical Aspects. Int J Mol Sci 2021; 22:ijms22084255. [PMID: 33923907 PMCID: PMC8074005 DOI: 10.3390/ijms22084255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of the ligaments of the cervical spine; in some cases, it may result in dysphagia. The condition is more common in men over 50 years of age with metabolic disorders, and it is often asymptomatic and not a major issue for patients. The etiology of DISH is poorly understood, and known genetic factors indicate multiple signal pathways and multigene inheritance. In this review, we discuss the epidemiological, clinical, and etiological aspects of DISH with a special focus on dysphagia.
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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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Dąbrowski M, Sulewski A, Kaczmarczyk J, Kubaszewski Ł. Surgical treatment of diffuse idiopathic skeletal hyperostosis of cervical spine with dysphagia - Case report. Ann Med Surg (Lond) 2020; 57:37-40. [PMID: 32714523 PMCID: PMC7369420 DOI: 10.1016/j.amsu.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Diffuse idiopathic skeletal hyperostosis of cervical spine can lead to dysphagia. Presentation of case A 73-year-old male weighing 110 kg and diagnosed with diffuse idiopathic skeletal hyperostosis in cervical spine with dysphagia. Patient manifested local pain of neck, a gradual limitation of spinal mobility. The surgery decision was based on swallowing problems, not pain in the spine. Before surgery radiographs, magnetic resonance images, computed tomography of the cervical spine and gastroscopy were obtained. Osteophytes were removed from the anterior approach with present otolaryngologist by surgery. Discussion In this case used gastroscopy, CT and MRI for diagnostics. During the procedure we had support otolaryngologist. The patient has not been found a stenosis spinal canal and neurological symptoms. We were removed the ostheophytes. Interbody implants have not been applied. Conclusion Disc degeneration disease itself can be asymptomatic or not a dominant problem for the DISH patients. Clinical signs may pharyngoesophageal and tracheal compression, causing dysphagia, shortness of breath and stridor. In this case, the cervical spine was stability and not demonstrated a stenosis in the spinal canal. Isolate removing of the osteophytes without implants in DISH of cervical spine can be enough solution.
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Affiliation(s)
- Mikołaj Dąbrowski
- Department of Spine Orthopedics and Biomechanics, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland.,W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Adam Sulewski
- W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Jacek Kaczmarczyk
- W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Łukasz Kubaszewski
- Department of Spine Orthopedics and Biomechanics, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland.,W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
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Kumar M, Shahi PB, Adsul N, Acharya S, Kalra KL, Chahal RS. Progressive dysphagia and dysphonia secondary to DISH-related anterior cervical osteophytes: A case report. Surg Neurol Int 2020; 11:69. [PMID: 32363064 PMCID: PMC7193212 DOI: 10.25259/sni_61_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH)-related anterior cervical osteophytes is not uncommon. However, this rarely leads to dysphonia and/or dysphagia along with life- threatening airway obstruction requiring emergency tracheotomy. Case Description: A 56-year-old male presented with progressive dysphagia and dysphonia secondary to DISH-related anterior osteophytes at the C3–C4 and C4–C5 levels. The barium swallow, X-ray, magnetic resonance imaging, and computed tomography scans confirmed the presence of DISH. Utilizing an anterior cervical approach, a large beak-like osteophyte was successfully removed, while preserving the anterior annulus. After clinic-radiological improvement, the patient was discharged with a soft cervical collar and nonsteroidal anti-inflammatory drug (NSAID). Conclusion: Large anterior osteophytes in Forestier disease/DISH may cause dysphagia and dysphonia. Direct anterior resection of these lesions yields excellent results as long as other etiologies for such symptoms have been ruled out.
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Affiliation(s)
- Manoj Kumar
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
| | - Prem Bahadur Shahi
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
| | - Nitin Adsul
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
| | - Shankar Acharya
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
| | - K L Kalra
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
| | - R S Chahal
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, Delhi, India
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