Cervical osteophyte resulting in compression of the jugular foramen

Abstract

<jats:p>Jugular foramen syndrome is a condition characterized by unilateral paresis of cranial nerves IX, X, and XI in the setting of extrinsic compression. Here, the authors describe the case of a giant cervical osteophyte resulting in compression of the jugular foramen. A 74-year-old man who presented with progressive dysphagia and dysarthria was found to have right-sided tongue deviation, left palatal droop, and hypophonia. His dysphagia had progressed to the point that he had lost 25 kg over a 4-month period, necessitating a gastrostomy to maintain adequate nutrition. He underwent extensive workup for his dysphagia with several normal radiographic studies. Ultimately, CT scanning and postcontrast MRI revealed a posterior osteophyte arising from the C1–2 joint space and projecting into the right jugular foramen. This resulted in a jugular foramen syndrome in addition to delayed filling of the patient's right internal jugular vein distal to the osteophyte. Although rare, a posterior cervical osteophyte should be considered in cases of jugular foramen syndrome.</jats:p>

Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine

“…The often (sub)acute onset of symptoms, however, implies that mechanical obstruction by (slow) bone growth might not be the only contributor in the pathogenesis of these symptoms [ 4 ]. Several authors described other mechanisms that could also contribute to dysphagia or airway obstruction such as inflammation of soft tissues surrounding the ossification, nerve entrapment, limited movement of the epiglottis/larynx and retention of food due to the bone mass [ 15 – 18 ]. In the current study only the contribution of the mechanical obstruction was investigated and only the vertebral levels C4, C5 and C6 were analyzed on the CT images.…”

Extrinsic venous compression secondary to spine osteophytes

“…1 Other rare and less frequent causes of extrinsic compression have been described, such as vein compression secondary to osseous structures. 5 Osteophytes are beaked osseous outgrowths at the margins of articular surfaces, often associated with deteriorating changes of articular cartilage. They are the most common aspect of osteoarthritis, and they can rarely cause symptoms by compression of the adjacent anatomic structures, such as nerves, vessels, bronchi, and esophagus.…”

“…6 They usually occur in the vertebral bodies of the cervical spine and are radiographically found in approximately 20%-30% of the elderly population. 5 Less frequently, they grow in the thoracic and lumbar spine. On the former, they might cause compression of the splanchnic nerves or the sympathetic trunk, and if they grow on the latter, they might be capable of reducing venous outflow from the inferior vena cava or the iliac veins.…”