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.

Keywords: cervical spine; diffuse idiopathic skeletal hyperostosis; dysphagia.

Figure 1

The lateral radiograph of cervical spine shows characteristic flowing ossification along the anterior aspect of the cervical vertebrae from C2–C5.

Figure 2

The preoperative CT scan of the cervical spine reveals continuous but irregular flowing hyperostosis alongside the anterior aspect of the whole cervical vertebrae. Abbreviation: CT, computed tomography.

Figure 3

The axial CT scan shows outgrowth osteophytes covering the anterior side of the vertebrae as well as local ossification of the posterior longitudinal ligament. Abbreviation: CT, computed tomography.

Figure 4

The preoperative T2-weighted sagittal magnetic resonance spin-echo image shows high signal intensity of bone marrow in C5–C7 as well as in the outgrowth hyperostosis. Note: MRI did not show obvious spinal stenosis and cord compression. Abbreviation: MRI, magnetic resonance imaging.

Figure 5

Histologic appearance of the removed tissue shows trabecular bone in the fibrous tissue with spindle cell proliferation. Notes: The resected sample also shows nonspecific diffuse chronic inflammation in the trabecular bone and connective tissue, infiltrated with a mixed population of lymphocytes, plasma cells, and macrophages. Hematoxylin and eosin (×100).

Figure 6

Postoperative lateral radiograph of cervical spine showing the anatomically normal structure of prevertebral tissues.