Dysphagia and Airway Obstruction Due to Large Cervical Osteophyte in a Patient With Ankylosing Spondylitis

Abstract

Anterior cervical osteophytes are excessive bony formation of cervical vertebra bodies. They are common but rarely symptomatic lesions mostly seen in geriatric population. Large anterior cervical osteophytes may cause symptoms such as dysphagia, dyspnea, dysphonia, and odynophagia. They have been attributed to multiple etiologies including diffuse idiopathic skeletal hyperostosis, following trauma, cervical spondylitis, and infectious spondylitis. However, symptomatic large anterior cervical osteophyte with ankylosing spondylitis is extremely rare. Surgical excision is the main treatment for symptomatic cases. We report a case of a 53-year-old man with airway obstruction and dysphagia due to large cervical osteophyte who has a history of ankylosing spondylitis, and we also addressed the etiological factors and management of large symptomatic cervical osteophytes.

Dysphagia as a symptom of anterior cervical hyperostosis – Case report

“…They develop as an effect of calcification and ossification of connective tissue, mostly within the anterior longitudinal ligament, which is characteristic for diffuse idiopathic skeletal hyperostosis (DISH), described for the very first time by Forestier and Rotes-Querol in 1950 [4,5]. The bone excrescence could also appear as the result of an injury, cervical spine infection, ankylosing spondylitis, as well as osteoarthritis [1,2,3].The most common symptoms are pain, radiculopathies, neurological disorders, dizziness and headache. Dysphagia, dyspnea and dysarthria occur in less than 1/3 of described cases, and the mechanism of their occurrence is not clearly understood [2,3,6,7].…”

“…A hyperostosis on the anterior surface of cervical spine is a relatively frequent occurrence. It may be a manifestation of diffuse idiopathic skeletal hyperostosis (DISH), degenerative changes, as well as cervical discopathy; bone excrescence also could appear as a result of an injury or cervical spine infection [1]. It commonly causes pain, limitations in the range of movements of the cervical spine, radiculopathies, and more serious neurological symptoms.…”

“…Ailments caused by direct compression on nearby anatomical structures (e.g. trachea, oesophagus) occur relatively less frequently [1,2,3].…”

A Case of a Paracardial Osteophyte Causing Atrial Compression

“…However, several complications have been reported due to the presence of vertebral osteophytes. The most frequent complications are myelopathy and radiculopathy which occur because of mechanical compression of the vertebral canal [3, 4] and dysphagia, caused by mechanical compression of the esophagus [5–15]. Other rarer complications may result from external compression of the trachea [16, 17], the bronchi [18], the adjacent arteries [19–22], and nerves [23, 24].…”

Postoperative respiratory difficulty due to asymptomatic anterior cervical osteophyte after brain tumor surgery: a case report

“…Most osteophytes are asymptomatic, but can produce symptoms ranging from dysphagia, dysphonia, and foreign body sensation to severe respiratory difficulty due to inflammation and edema arising from mechanical compression [23]. Dysphagia appears to be the most common presentation, caused by mechanical obstruction of pharyngo-esophagus by anterior cervical osteophyte [4]. Clinically manifested airway compression by anterior cervical osteophyte is very rare [5].…”