A case of obstructive sleep apnoea with anterior cervical osteophytes

Abstract

Osteophytes of the cervical spine are usually seen in elderly adults. When prominent, they have been blamed for dysphagia, cough, dysphonia and dyspnoea. This paper reports on an obstructive sleep apnoea (OSA) patient with cervical spinal osteophytes, one cause of airway obstruction. A 75-year-old male complained of pronounced snoring. The diagnosis was mild OSA, apnoea hypopnoea index was 9.4. Patient reported no restrictions in neck movements, experiences of neck pain or neck trauma. Previously, patient underwent a tonsillectomy due to discomfort in the pharyngeal region. A lateral cephalometric image was taken to observe airway before oral appliance therapy. The image revealed the presence of large osteophytes or sclerotic enthesopathy, lying on anterior surfaces from the fourth to seventh cervical vertebrae. A computed tomography (CT) image revealed the relationship of airway position to the spine. In the reconstructed three-dimensional (3D) image, the airway appeared displaced to the right of the craniomandiblar bone, with the hyoid bone similarly displaced in a manner to that of the airway. The spine also appeared displaced to the left side ofcraniomandiblar bone. Additionally, the 3D image revealed calcification of the stylohyoideum ligament and ligamentum nuchae. This present case highlights the necessity of CT examination for OSA patients. There were several ligament calcifications in the head and neck region. Cervical spine osteophytes, as a component of Forestier's or cervical spine disease, have been associated with dysphagia and dysphonia. It was reported that bilateral vocal cord paralysis was caused by osteophytes compressing the post-cricoid area of larynx.

Sleep apnea and cervical spine pathology

“…Risk factors commonly associated with osteophyte formation include obesity, diabetes mellitus, and diffuse idiopathic skeletal hyperostosis (DISH). DISH is a degenerative or metabolic disorder causing ossification of the anterior longitudinal ligament of the cervical vertebrae, and is known to produce osteophytes [18,19]. Other clinical symptoms of cervical osteophytes include dysphagia and dysphonia.…”

“…AHI values ranged from 9.4 to 42 [18]. A few of the patients also had the diagnosis of DISH [19][20][21]. Treatment modalities included constant positive airway pressure (CPAP), medical treatment, and surgery based on preferences and needs of the patients.…”

The Relationship between Anterior Tubercle of the Atlas to the Adjacent Oropharyngeal Airway Volume: Implication of Normalized Variables and Gender Differences

“…In this case report, the X-ray image revealed the presence of large osteophytes or sclerotic enthesopathy, lying on anterior surfaces from the fourth to seventh cervical vertebrae [7]. Furthermore, in the reconstructed threedimensional image, the airway appeared displaced to the right of the cranio-mandibular bone, with the hyoid bone displaced in the same manner to that of the airway.…”

Dysphagia due to anterior cervical osteophytes complicated with hypopharynx abscess

“…Symptoms involved with the spine are rigidity, decreased mobility and spinal column pain 5. Cervical osteophytes can also cause respiratory symptoms such as dyspnoea,6 aspiration pneumonia4 and sleep apnoea 7. The most common symptom is progressive difficulty with solid foods and eventually liquids.…”