Clinical evaluation of surgery for osteophyte-associated dysphagia using the functional outcome swallowing scale

Abstract

Purpose: To investigate the surgical outcome of patients with osteophyte-associated dysphagia (OAD) using the functional outcome swallowing scale (FOSS).

Methods: A retrospective chart review of 10 surgical cases of OAD (9 male and 1 female patient; mean age of 65 years) from 1982 to 2017 was performed, and radiographic evaluations were conducted by video fluoroscopic swallow study (VFSS) and conventional radiography. All OAD cases were treated at a single institution, and osteophytes were surgically resected by the anterior approach under gentle retraction of the affected esophagus. FOSS (0 for normal, 5 for worst) was used for clinical evaluations, and surgical complications were recorded.

Results: VFSS evaluation of OAD showed that the affected osteophyte was located at C4/5 in four patients, followed by C3/4 in three patients. The mean FOSS showed significant improvement from 2.5 preoperatively to 0.3 postoperatively, and no major surgical complications were recorded. Comorbidities were diabetes mellitus in four patients, ossification of the posterior longitudinal ligament in three patients, and lumbar spinal stenosis (LSS) in three patients.

Conclusion: Surgical treatment of OAD was promising, and all patients showed clinical recovery. Evaluation of dysphagia using FOSS was easy and reliable for OAD management, and FOSS 2 might be a good indication for surgical intervention.

Fig 1. Preoperative and postoperative lateral radiographs of patient no. 4.

(A) Cervical osteophytes at C5/6 and OPLL at C2/3. (B) Preoperative VFSS showed that the contrast medium was obstructed at C5/6 level and the esophagus was compressed. (C) Postoperative VFSS contrast medium was not obstructed, and the osteophyte at C5/6 was excised completely.

Fig 2. Lateral radiographs of patient no. 4 obtained 9 and 17 years after surgery (long-term follow-up).

(A) Nine years after surgery, recurrent anterior osteophytes were observed at the C3/4 and C5/6 levels. (B) Seventeen years after surgery, the osteophytes were gradually enlarged at the C3/4 and C5/6 levels.