Dysphagia caused by ventral osteophytes of the cervical spine: clinical and radiographic findings

Abstract

The purpose of our study was to demonstrate the clinical and radiographic findings in patients with dysphagia and ventral osteophytes of the cervical spine due to degeneration or as a typical feature of diffuse idiopathic skeletal hyperostosis (DISH, Forestier Disease). Since 2003 we encountered 20 patients with such changes in the cervical spine causing an impairment of deglutition. A total of 12 patients had one solitary pair of osteophytes of neighboring vertebrae, 4 patients revealed two pairs and 4 patients had triple pairs of osteophytes. Thirty-two osteophytes were observed totally. A total of 14 of these arose from the right, 15 from the left side and 3 from the middle of the anterior face of the vertebra. Ten patients suffered from DISH, while ten patients revealed osteophytes as a part of a degenerative disorder of the cervical spine. The osteophytes had an average length of 19 mm maximum anterior posterior range. Most of the osteophytes (16) were found in the segments C5/6 and C6/7. Osteophytes of vertebrae C3/4/5 occurred in six cases. Only in one case C2/3 was affected. Functional endoscopic evaluation of swallowing (FEES) revealed an aspiration of thin liquids in seven patients with osteophytes arising from the anterior face of the vertebra C3/4/5 restricting the motility of the epiglottis, which seemed not to close the aditus laryngis. Retention of solids in the piriform sinus on the side obstructed by an osteophyte (C4/5) could also be repeatedly evidenced through FEES. In one case, a strong impairment of the voice because of an immobility of the right vocal cord due to mechanical obstruction by an osteophyte was the indication for surgical removal of the structure. Thus, the dysphagia of this patient was reduced and his voice turned to normal. The development of symptoms in patients with ventral osteophytes was very much related to the location of the structures. Moreover, the clinical symptoms were to some extent dependent on the size of the osteophytes, although there was no direct correlation between size of the structure and severity of the patient's complaint.

Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis

“…Osteophytes arising from the anterior face of C3/4 and C4/5 levels are shown to cause intradeglutitive aspiration of Xuids by restricting the laryngeal closure by the epiglottis during deglutition [11]. Additionally, osteophytes at C5/6 and C6/7 levels are shown to complicate the deglutition of food on the respective side of the pharynx, consequently resulting in a retention of solid food in the pharynx with the possibility of postdeglutitive aspiration [11]. In our study, the mean postoperative increase in size of the largest recurrent osteophyte in each patient was about 1 mm/year.…”

Surgical Treatment for Cervical Diffuse Idiopathic Skeletal Hyperostosis as a Cause of Dysphagia

“…Seidler et al reported that osteophytes larger than 10 mm thickness lead to symptoms 8) . However, case 1 had no complaint until the size of osteophytes progressed to 31 mm.…”

Current trends: Operative Strategy for the Management of Cervical Radiculopathy

“…Seidler et al suggested cervical osteophytes present on anterior ventral surface likely to cause esophageal compression, impinge on the hypopharynx due to inflammation, edema, chronic direct irritation . [26,27,28]. Sometime spurling sign and tinel's sign are positive which is called double crush phenomena i.e cervical radiculopathy with peripheral neuropathy.…”