Dysphagia caused by Anterior Cervical Osteophyte: A Rare Entity Revisited

Abstract

Large anterior cervical osteophytes can occur in degeneration of the cervical spine, cervical spondylosis or in diffuse idiopathic skeletal hyperostosis (DISH). Voluminous anterior cervical osteophytes which can develop from C3 to C7 can cause narrowing of the pharyngoesophageal segment by external compression and may cause dysphagia, which may be life threatening when it is associated with aspiration and or dyspnea. The objective of this case report is to highlight how commonly occurring anterior cervical osteophytes may become an unrecognized cause for life-threatening dysphagia. The clinical and radiographic findings in patient with dysphagia and ventral osteophytes of the cervical spine due to degeneration are demonstrated. The anterolateral approach for removal of these osteophytes is described.

Timing for surgical intervention in DISHphagia

“…As published in most case series, this condition occurs more frequently in men, typically in their seventh decade. [12] These demographic data are similar to those noticed in this study.…”

“…A close percentage (58%–71%) of surgically treated patients were reported in other similar studies. [12] In all cases in this study, the anterolateral cervical approach was utilized being the most familiar and allows direct access to the targeted area and pathology. The same approach was also widely utilized in three-quarters of the operated cases in the relative literature,[7] most probably for the same reasons.…”

Dysphagia Caused by Anterior Cervical Osteophytes: A Rare Entity!

“…The prevalence of anterior cervical osteophytes in the elderly ranges from 20%-30%, mostly seen in males [1]. The majority are asymptomatic, and large osteophytes causing dysphagia are rare.…”

“…Before the diagnosis of ACOs is made, all patients should have a routine diagnostic workup for dysphagia to rule out intrinsic causes such as diverticula, oesophageal stricture, motility problems, and neoplasms [3]. For most patients, the diagnosis is established by a thorough history, indirect laryngoscopy, and lateral cervical spine X-ray images [1]. Upper gastrointestinal endoscopy can be performed in patients with cervical osteophytes, but cautiously, considering the risk of esophageal perforation [4].…”

“…Although anterior cervical osteophytes (ACOs) are not an uncommon entity in the elderly, they are rarely identi ed as an etiology for dysphagia in the surgical literature [1]. Diffuse idiopathic skeletal hyperostosis (DISH) and cervical spondylosis are two pathological conditions that give rise to anterior cervical osteophytes [1,2], but most of the anterior cervical osteophytes occur in the degenerative diseases of the spine, where they are formed by reactive ossi cation of the anterior longitudinal ligaments [3]. Anterior cervical osteophytes should be considered as a cause of dysphagia only after excluding other pathological conditions of the esophagus, such as tumors, gastric ulcers, strictures, achalasia, and neuromuscular diseases [3].…”