Long-term Results of Surgical Treatment for Symptomatic Anterior Cervical Osteophytes

Vodičar, Miha; Košak, Robert; Vengust, Rok

doi:10.1097/bsd.0b013e31829046af

Cited by 16 publications

(20 citation statements)

References 21 publications

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“…24,53,[55][56][57] If the extrinsic cause is more prominent, in case of more severe problems and impairment of the quality of life, surgical resection of the osteophytes via a standard anterior approach is performed. 4,[24][25][26][27][28] This can achieve sufficient improvement with a low morbidity rate 4,17 ; regression of the symptoms can occur quickly (in up to 2 weeks) but may sometimes take months. 21,26,27,30,58 The results are more limited the more advanced the changes in the esophagus itself are (inflammation, fibrosis, impaired peristalsis, etc.).…”

Section: Discussionmentioning

confidence: 99%

“…66 Recurrent cervical osteophytes are rare, develop slowly, and have been described in long-term follow-up over 10 years. 4,17,[29][30][31] Routine additional fusion is therefore discussed not only due to possible operationinduced instability, but also because segmental mobility can promote the further development of osteophytes. 9,[29][30][31] There is experience in the prophylaxis of ossification in particular in connection with the implantation of hip replacements.…”

Section: Discussionmentioning

confidence: 99%

“…4,29 The resection of the osteophytes does not eliminate the underlying disease, so new ossification can develop. 4,17,[29][30][31] Therefore, routinely performed additional fusion is discussed not only due to potential surgery-induced instability, but also because segmental mobility can promote the development of osteophytes. 9,[29][30][31] Experience in the prevention of ossification after surgery is available in particular for hip replacement surgery, where the administration of indomethacin 26,32,33 and radiation 34,35 has been established as a preventive measure.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of anterior cervical osteophytes causing dysphagia

Ruetten

Baraliakos

Godolias

et al. 2019

J Orthop Surg (Hong Kong)

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Dysphagia due to anterior cervical osteophytes is a rare condition. However, it can become serious enough to permanently impair the quality of life up to making normal food intake impossible. If conservative treatment fails, there is the option of surgical resection of the osteophytes. The objective of this study was to assess the outcomes of resections of anterior cervical osteophytes causing spondylogenic dysphagia, taking literature into consideration. Method: Resection of anterior cervical osteophytes using a standard anterior approach was performed in 14 consecutive patients with spondylogenic dysphagia between 2009 and 2015. Indomethacin or radiation was used to prevent recurrence. Imaging and clinical data were collected in follow-up examinations over an average of 50 months. Results: The osteophytes were sufficiently resected in all cases. Anterior plates were placed in three patients due to pronounced segmental mobility. Five patients were given recurrence prevention in the form of indomethacin, nine with radiation. One patient required revision surgery for a hematoma. No other serious complications were observed. All patients had significant improvement of their symptoms. No recurrences or signs of increasing instability were found during the follow-up period. Conclusion: When conservative treatment fails, surgical resection of cervical osteophytes is a sufficient method for treating spondylogenic dysphagia. High patient satisfaction and improvement of the quality of life are achieved with a low complication rate. Routine additional stabilization has been discussed as recurrence prevention. Prophylaxis using indomethacin or radiation, known primarily from hip replacement, also appears to be an option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of anterior cervical osteophytes causing dysphagia

Ruetten

Baraliakos

Godolias

et al. 2019

J Orthop Surg (Hong Kong)

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“…[4][5][6] When these bony growths become large enough, they can lead to dysphagia, dysphonia, dyspnea, and obstructive sleep apnea. 3,[6][7][8] Previous studies have shown that less than 1% of cervical osteophytes lead to dysphagia, and only 1.7% of cases of dysphagia are caused by cervical osteophytes. 3,5,9 Osteophytes may cause dysphagia via multiple mechanisms, including mechanical compression of the esophagus, interference with normal epiglottis movement, compression of the Auerbach's myenteric plexus, and the induction of inflammation and edema about the esophagus, which can lead to fibrosis and adhesions, preventing normal motility and causing cricopharyngeal spasm.…”

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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“…Complications associated with osteophyte formation are numerous (dysphagia, thoracic aortic compression, vena cava obstruction, nerve root compression) and affect most structures located in close-proximity to the spine. As a consequence, they are generally viewed as a degenerative condition and can be removed surgically by traditional or minimally invasive techniques during spinal surgery, when they lead to a disability or neurological symptoms [ 1 , 7 ]. Recently, it was suggested that vertebral osteophytes primarily stabilize the spine in bending and increase its resistance in compression [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Substantial vertebral body osteophytes protect against severe vertebral fractures in compression

et al. 2017

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Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures.

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Long-term Results of Surgical Treatment for Symptomatic Anterior Cervical Osteophytes

Abstract: Symptomatic ventral cervical osteophytes can be successfully treated by surgery. In the majority of patients, osteophytes do not regrow significantly in the long term, precluding the need for prophylactic instrumented fusion after osteophyte resection.

Cited by 16 publications

References 21 publications

Surgical treatment of anterior cervical osteophytes causing dysphagia

Surgical treatment of anterior cervical osteophytes causing dysphagia

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Substantial vertebral body osteophytes protect against severe vertebral fractures in compression

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