Progressive dysphagia and neck pain due to diffuse idiopathic skeletal hyperostosis of the cervical spine: a case report and literature review

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is considered an underdiagnosed and mostly asymptomatic nonprimary osteoarthritis. The etiology of DISH remains unknown and the validated diagnostic criteria are absent. This condition is still recognized radiologically only. Rarely, large projecting anterior osteophytes result in esophageal impingement and distortion leading to dysphagia. We report the case of progressive dysphagia and neck pain due to DISH of the cervical spine in a 70-year-old man, which was surgically removed with excellent postoperative results and complete resolution of symptoms. Imaging studies, surgical findings, and histopathological examinations were used to support the diagnosis. The patient was successfully treated with total excision of the anterior osteophytes with no evidence of recurrence 12 months after surgery. In this report, we also discuss the clinical features and perioperative considerations in combination with a literature review. Our patient illustrates that clinicians should be aware of this rare clinical manifestation as the presenting feature of DISH in cervical spine. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment.

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

“…However, previous reports did not address the extent of the osteophyte resection in detail 16,18) . Some surgeons prefer the complete resection of all cervical spine osteophytes [19][20][21] . However, it was also reported that dysphagia persisted unchanged following surgery with extensive C3-6 osteophyte resection 20) .…”

Symptomatic dyspnoea addressed by excision of ossified anterior longitudinal ligament

“…OALL is generally considered as a part of DISH and is classified into three types on the radiological basis 4. Segmental type is defined as partial or total ossification over a vertebral body without involving the disc space.…”

Dysphagia and Cervical Vertebral Osteophytes: Forestier’s Disease?

“…There is no conclusive correlation between symptoms and the size of the osteophytes: however, advanced age has been correlated with the severity of symptoms. This leads to various reports finding the strongest correlation with DISH being sex and age [1,2,5,6]. …”

“…It is commonly progressive in nature and acute presentation is very unusual. There are several theories to explain dysphagia [2,[5][6][7]: a) Growth where the esophagus is anatomically anchored. b) Physical obstruction of the esophageal lumen by extrinsic compression.…”

“…The specific radiological criteria for the diagnosis of Forestier's disease were described by Resnick and Niwayama in 1970 and are still used today [1][2][3]5,6,8 Cervical spinal osteophytes are estimated to affect 10 to 30% of the general population; nevertheless they tend to be largely asymptomatic. Symptoms as dysphagia, dysphonia and/or dyspnea can be observed when hyperostosis involves the anterior margin of the cervical vertebrae, more frequently (75%) in the population above 60 years of age [1][2][3].…”