Anterior cervical spine surgery for treatment of secondary dysphagia associated with cervical myelopathy in patient with Forestier's disease

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.

An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS)

“…DISH is a systemic disease characterized by excessive calcification of the anterior spinal body, primarily at the T8-T10 level [3] . The etiology is still unclear; the prevalence of DISH in the Asian population ranges between 10 and 25% [5] . The majority of patients are asymptomatic, although compression of the anterior component of the cervical spine can cause dysphagia, recurrent pneumonia, and airway obstruction [2] , [6] , [7] .…”

“…Reformation of an osteophyte has been found to occur at a rate of 1 mm/year; however, recurrence of symptoms after surgical resection occurs slowly and in very few patients [10] . Apart from surgical resection, additional fusion, NSAIDs, bisphosphonate, indomethacin and radiotherapy have been used to reduce the risk of recurrence, but there are no precise guidelines for prophylaxis to prevent recurrence [5] , [11] .…”

Diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis—similarities and differences

“…Similar to axSpA, also Achilles tendon and plantar fascia are affected [2]. While in daily practice arthritis and enthesitis are more common in axSpA than in DISH, studies with small numbers of patients demonstrated the presence of inflammatory signal on power Doppler but also presence of erosions also in DISH-associated enthesopathies [33]. In addition, typical extra-musculoskeletal manifestations of axSpA, such as uveitis, psoriasis, and inflammatory bowel disease are not found in patients diagnosed with DISH.…”