ABSTRACT
Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.
Subject(s)
Humans , Middle Aged , Deglutition Disorders , Diagnosis, Differential , Dysphonia , Esophagus , Foreign Bodies , Hyperostosis, Diffuse Idiopathic Skeletal , Longitudinal Ligaments , Neck , Neck Pain , Osteophyte , Pharynx , Physical Examination , Recurrence , Sensation , SpineABSTRACT
La hiperostosis esquelética idiopática difusa (DISH) o enfermedad de Forestier es una patología que presenta como principal manifestación la osificación del ligamento longitudinal anterior (LLA) y la formación de puentes óseos intervertebrales. Las repercusiones otorrinolaringológicas con poca frecuencia son descritas, siendo la disfagia, la disfonía y la disnea los síntomas más comunes. Presentamos dos casos clínicos de DISH en pacientes de sexo masculino de setenta y cuatro años y otro de setenta y un años respectivamente, con disfagia de varias semanas de evolución asociado a disfonía y disnea en un caso. Realizamos la discusión de ambos casos y de las manifestaciones otorrinolaringológicas de esta patología.
Diffuse idiopathic skeletal hiperostosis (DISH) or Forester's disease is a pathology characterized by the ossification of the anterior longitudinal ligament (ALL) and the formation of intervertebral osseous bridges. The otolaryngology repercussions are rarely described, dysphagia, hoarseness and dyspnea being the most common symptoms. We present a clinical case of two patients with DISH in a 74 year-old male patient and another of 71 year-old respectively, suffering from several weeks of dysphagia associated with dysphonia and dyspnea in one case. We are going to discuss both cases together with the otolaryngological manifestations of this pathology.
Subject(s)
Humans , Male , Aged , Deglutition Disorders/etiology , Hyperostosis, Diffuse Idiopathic Skeletal/complications , Dyspnea/etiology , Dysphonia/etiology , Hyperostosis, Diffuse Idiopathic Skeletal/surgery , Hyperostosis, Diffuse Idiopathic Skeletal/diagnostic imagingABSTRACT
Diffuse idiopathic skeletal hyperostosis is a condition of unknown cause, characterized by calcification and ossification of entheseal sites, which generally causes ankylosis of the spinal column and ossification of the extra-spinal ligaments or tendons. The case reported is from the cervical region of the spinal column of skeletal remains. Knowledge of the multiple clinical and functional implications analyzed is of great importance when approaching patients with said manifestations.
La hiperostosis esquelética difusa idiopática es una afección de causa desconocida, caracterizada por calcificación y osificación de sitios de entesis, que generalmente ocasiona anquilosis de la columna vertebral y osificación de ligamentos o tendones. El caso reportado es a partir de la región cervical de la columna vertebral de un resto esquelético. El conocimiento de las múltiples implicaciones clínicas y funcionales analizadas es de gran importancia para el momento del abordaje de pacientes con dichas manifestaciones.