Clinical and radiological features of Forestier's disease presenting with dysphagia

Abstract

Background: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a rheumatologic condition characterized by ossification of the spinal ligaments and tendons. Large anterior osteophytes are typically present in the lower cervical levels, while upper cervical ossification resulting in dysphagia is very rare.

Methods: Here, we presented a patient with Forestier's disease involving massive ossification of the anterior longitudinal ligament extending from C3 to C4 downward contributing to severe dysphagia.

Results: A 65-year-old male presented with cervical pain and dysphagia. The computed tomography of the cervical spine demonstrated massive anterior longitudinal ligament ossification (DISH) extending from C3 to C7. There was an additional large osteophyte at the C3-C4 level, and also a high-grade intracanalicular C6-C7 cervical stenosis due to ossification of the posterior longitudinal ligament. The patient was offered surgical intervention (e.g., resection of the C3-C7 anterior DISH and anterior cervical discectomy/fusion at the C6-C7 level), but he declined.

Conclusions: When conservative management fails to resolve severe dysphagia for cervical DISH/Forestier's disease, anterior surgical resection is typically performed. In this case, the patient refused surgery and opted for conservative management strategies.

Keywords: Cervical spine; Forestier's disease; diffuse idiopathic skeletal hyperostosis; non-surgical options.

Figure 1

Sagittal multiple planar reconstruction (MPR) computed tomography scan showing C3-C4 anterior ossification with large osteophytes. White arrow: trachea kinking on the superior margin of the large anterior osteophyte

Figure 2

Axial computed tomography scan showing upper C3-C4 anterior ossification with posterior impression on the dorsal surface of the trachea and its initial displacement

Figure 3

Axial computed tomography scan showing C6-C7 high-grade stenosis with calcification of the intervertebral disc and posterior osteophyte

Figure 4

Three-dimensional volume rendering showing the cervical spine with anterior ossification

Figure 5

Magnetic resonance imaging showing the displacement of larynx and trachea and the kinking of the esophagus caused by C3-C4 anterior osteophyte. White arrow: trachea kinking on the superior margin of the large anterior osteophyte