Ossification of the anterior longitudinal ligament and Forestier's disease: an analysis of seven cases

Abstract

A retrospective review was conducted on the records and radiographs of six symptomatic patients and one asymptomatic patient with Forestier's disease. No other series of patients with this disease is found in the neurosurgical literature. Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is an idiopathic rheumatological abnormality in which exuberant ossification occurs along ligaments throughout the body, but most notably the anterior longitudinal ligament of the spine. It affects older men predominantly; all of our patients were men older than 60 years of age. The disease is usually asymptomatic; however, dyspnea, dysphagia, spinal cord compression, and peripheral nerve entrapment have all been documented in association with the disorder. Five of the six symptomatic patients presented with dysphagia due to esophageal compression by calcified anterior longitudinal ligaments, and one patient developed recurrent spinal stenosis when scar tissue from a previous decompressive laminectomy became calcified. All patients responded well to surgery. Two of the four patients who underwent removal of cervical osteophytes required several months following surgery for the dysphagia to resolve. This would support the hypothesis that not all cases of dysphagia in Forestier's disease are due to mechanical compression. Dysphagia may result from inflammatory changes that accompany fibrosis in the wall of the esophagus or from esophageal denervation. Evaluation of dysphagia even in the presence of Forestier's disease must rule out occult malignancy. The authors' experience suggests that dysphagia in the setting of Forestier's disease is an underrecognized entity amenable to surgical intervention.

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

“…Many surgical reports about DISH-related dysphagia have been described in the literature [1,3,4,7,12,13,16]: however, few of these include postsurgical results for more than 2 years. Except for a few reports in the Japanese literature [3,13], little study has been given to the regrowth of osteophytes after surgical resection.…”

“…Conservative treatment has been indicated for the initial management of these cases [2,16]. Surgical resection of the osteophyte has been reported to be an effective treatment for severe cases and/ or cases with airway obstruction [1,3,4,7,[12][13][14].…”

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

“…1 X-ray and CT scan documented OALL at C2-C7, OPLL at C3-C7 and T1-2, and OLF at T1-2. a OALL at C2-C7, b OPLL (black arrow) and OLF (white arrow) at T1-2, c no sacroiliac erosion characterized by ligamentous ossification of the anterolateral side of the spine, sparing the disc and joint space [1][2][3][4]. Although typically asymptomatic, DISH has been associated with neurological problems [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 2), of which the reported rate is 4% [21].…”

Dysphagia Due to Forestier Disease: Three Cases and Systematic Literature Review

“…Seven cases were reported each from Germany [12][13][14] and the USA [15][16][17]. Five cases were reported each from the UK [18][19][20][21][22] and Chile [23].…”