Progressive dysphagia secondary to cervical osteophytosis due to diffuse idiopathic skeletal hyperostosis (DISH)

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory systemic disease characterised by ossification of ligaments and entheses. Although it is usually asymptomatic, in its cervical localisation it can cause dysphagia secondary to oesophageal compression or functional limitation due to ankylosis. We present the case of a 58-year-old male with progressive dysphagia of three years' evolution, with an EAT-10 score of 34/40. Surgical resection of the impressive osteophyte formation was performed by an anterior cervical spine approach and precision drilling. Within a few weeks, there was a reported progressive improvement and complete resolution of the symptoms. The pathophysiological mechanisms involved and current recommendations on surgical indications, prognosis and follow-up are discussed. Awareness of this therapeutic option is paramount in non-surgical specialties, and interdisciplinary discussion is recommended.

Keywords: anterior cervical approach; cervical ankylosis; cervical osteophyte; diffuse idiopathic skeletal hyperostosis (DISH); dysphagia.

Figure 1

(A) Preoperative cervical computed tomography (CT), sagittal plane. A 9 mm-thick anterior cervical osteophyte is observed extending from C3 to C5, with signs of an incipient osteophyte at C6; (B) Postoperative lateral cervical X-ray obtained on the first postoperative day. Complete resolution of the anterior cervical osteophyte is evident. Prevertebral soft tissue swelling is also observed; the dysphagia subsided over the ensuing few weeks.

Figure 2

Intraoperative view of the anterior cervical approach. (A) Exposure of the osteophyte, draped over levels C3–C5, prior to drilling. (B) During drilling. The upper limit of the resection is visible cranially, corresponding to the C2–C3 disc space.