Airway management of a patient with Forestier's disease

Abstract

Forestier's disease, also called diffuse idiopathic skeletal hyperostosis (DISH), is a noninflammatory enthesopathy, ossifying the anterolateral spine and sparing the disc and joint space in elderly men, mostly at thoracic levels. Intubation difficulty and spinal cord injury are potential problems when managing the airway in DISH patients. We report a patient with Forestier's disease who was admitted for osteophyte resection. After taking a detailed history, we evaluated the airway carefully. Also, preparation for difficult intubation was done. After a rapid sequence induction, we performed mask ventilation and laryngoscopy without hyperextension of the neck, to prevent spinal cord injury. Although the worldwide standard for management of the airway in DISH patients is awake fiberoptic intubation, we chose conventional laryngoscopy because a fiberoptic bronchoscope was not available.

Postoperative obstructing laryngeal edema in patients with diffuse idiopathic skeletal hyperostosis of cervical spine -A report of two cases-

“…Careful clinical evaluation of the airway prior to surgery and a predetermined approach for handling unexpected difficult intubation have been emphasized [3]. Fiberoptic-assisted awake intubation is the safest choice in DISH patients when difficult intubation is suspected [5]. In our first case, intubation was performed with a lightwand without difficulty, but the second patient required preoperative tracheostomy.…”

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

“…1 X-ray and CT scan documented OALL at C2-C7, OPLL at C3-C7 and T1-2, and OLF at T1-2. a OALL at C2-C7, b OPLL (black arrow) and OLF (white arrow) at T1-2, c no sacroiliac erosion characterized by ligamentous ossification of the anterolateral side of the spine, sparing the disc and joint space [1][2][3][4]. Although typically asymptomatic, DISH has been associated with neurological problems [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 2), of which the reported rate is 4% [21].…”

Safe intubation with a gum-elastic bougie in a patient with Forestier's disease

“…The prevalence of spinal hyperostosis was reported to be relatively high [3]. Many more cases of diffi cult airway in patients with DISH may be overlooked, as occurred in our patient [1].…”

“…To the editor: We read with great interest the case report by Ozkalkanli et al [1] regarding airway management of a patient with Forestier's disease.…”

“…Recently, the patient consulted an orthopedic surgeon and fi ndings of skeletal hyperostosis were diagnosed as DISH. Following the discussion of Ozkalkanli et al [1], spinal hyperostosis can predispose to chronic myelopathic symptoms and acute spinal cord injury by reducing the fl exibility of the spine. The prevalence of spinal hyperostosis was reported to be relatively high [3].…”