Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte

Choi, Hee Eun; Jo, Geun Yeol; Kim, Woo-Jin; Kwon, Hwan; Kwon, Jun Koo; Park, Se-Heum

doi:10.5535/arm.2019.43.1.27

Cited by 19 publications

(21 citation statements)

References 24 publications

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“…10,11 Most cases can be treated nonsurgically with diet modification, muscle relaxants, anti-inflammatories, postural changes during eating, phonophoresis, and swallowing rehabilitation programs. 12,13 When conservative treatment fails, surgical osteophyte resection can improve hyoid movement, leading to enhanced upper esophageal sphincter opening 11 and symptoms of dysphagia. 3,6,7,11,[14][15][16][17][18][19][20][21][22][23][24] Given the relative rarity of symptomatic anterior cervical osteophytes being treated with surgical resection, the current literature consists of case reports and case series with relatively few patients.…”

Section: Introductionmentioning

confidence: 99%

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Kolz

Alvi

Bhatti

et al. 2020

Global Spine Journal

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Study Design: This was a retrospective cohort study. Objectives: When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. Methods: Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). Results: Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia ( P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. Conclusions: Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.

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Section: Introductionmentioning

confidence: 99%

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Kolz

Alvi

Bhatti

et al. 2020

Global Spine Journal

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“…Anterior cervical osteophytes (ACOs) are bony protrusions of the spine seen primarily in the geriatric male population, often those 65 years and older, as a result of degenerative spinal changes, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis (DISH) [1][2][3][4][5][6]. It is estimated that ACOs occur in 10-30% of the population, are typically benign, and are most often asymptomatic [7,8].…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

“…In some individuals ACOs compress the pharynx and/or esophagus or cause soft tissue inflammation narrowing the nasopharynx resulting in dysphonia, dyspnea, and/or dysphagia [4,6,9]. Although additional research is needed to determine the exact mechanism impacting the presence of ACOs, Choi et al [2] suggests that C3-5 is most often where dysphagia secondary to ACOs occurs. Physiologically, this is where epiglottic inversion for airway protection occurs which is highly correlated with the process of swallowing.…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

“…A small percentage of patients require surgical intervention when conservative measures fail and worsening of dysphagia or dyspnea symptoms occur. Often, surgical intervention is not pursued for those in the geriatric population due to risks related to patients' prior comorbidities or post-surgical concerns regarding soft tissue edema and laryngeal nerve damage [2]. Osteophytectomy is performed under general anesthesia and consists of anterolateral and posterolateral approaches, both of which have been found to have certain advantages.…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

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Impact of Osteophytectomy on Swallowing Function in a Patient with Chronic Dysphagia

Howard¹,

Phillips²,

Henley³

et al. 2020

obm geriatr

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Anterior cervical osteophytes are common in the geriatric population. Dysphagia can occur in individuals suffering from these spinal abnormalities. Surgical intervention is an uncommon course of treatment for these patients, but is often utilized as a last resort with the hope of swallow recovery. The purpose of this article is to highlight a unique case study documenting the required treatment course for dysphagia associated with osteophytes and subsequent osteophytectomy. We review current literature of both conservative and surgical interventions, as well as discuss the rehabilitation course for a complex patient with persistent dysphagia. Various outcome measures were utilized during the patient’s inpatient stay to track progress including the Functional Oral Intake Scale (FOIS), the Bolus Residue Scale (BRS), Penetration Aspiration Scale (PenAsp), Dysphagia Outcome Severity Scale (DOSS), and a Modified Barium Swallow Study (MBSS). The patient received rehabilitative training including oral motor and pharyngeal strengthening exercises, respiratory strengthening, speech instruction, cognitive retraining, and instrumental assessment. Following osteophytectomy and dysphagia rehabilitation the patient did not show any change based on a repeat MBSS which revealed the necessity for the patient to remain nothing per oral (NPO). The patient demonstrated an inability to manage his secretions, requiring continual suctioning. Upon discharge the patient remained NPO with the exception of ice chips, utilized a PEG for nutrition, and had a red capped tracheostomy. He was on room air and independently utilized oral suction as needed for secretion management. Our patient’s clinical course was not aligned with typical osteophytectomy recovery as progress after his 25-day inpatient stay was limited. The goal of this case study is to contribute information to the limited and variable data available regarding treatment options, outcome measures and timelines for recovery as it pertains to patients who undergo an osteophytectomy.

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“…Although spinal osteophytes are common, occurring in one in every five elderly patients, less than 1% of osteophytes lead to dysphagia. [1][2][3][4][5] This case illustrates how a thorough investigation is essential to evaluate the cause of dysphagia. The patient is currently being managed through a conservative approach due to personal preference.…”

mentioning

confidence: 99%