Cervical Osteophytes Increase the Risk for Foreign Body Impaction: A 171-Patient Case-Control Study.

Abstract

The aim of this study is to define the relationship between anatomical and pathological cervical structures and the impaction of ingested foreign bodies (FBs). The effects of such structures on deglutition have been previously discussed, however their contribution to FB impaction has not yet been examined. This was a retrospective case-control study of 171 patients who underwent computed tomography (CT) scans over the period 2008-2014: 57 patients with an esophageal or hypopharyngeal FB; the other 114 comprised the control group, selected using the 'neighbor control' method. CT scans were reviewed for measurements of cervical structures. The mean age was 63±13years and 55±17years in the case and control groups, respectively (p-value=0.003). Age was the only demographic or clinical characteristic which demonstrated a significant difference. Overall, 24 patients had cervical osteophytes: 28%(16) with an impacted FB, compared with 7%(8) from the control group (p-value<0.001). Of the patients with osteophytes and impacted FBs, 62.5% had the FB lodged at a vertebral level corresponding to their osteophytes, while another 18.75% had the FB within three vertebral levels above the osteophytes. Stepwise logistic regression revealed that osteophytes were a significant factor, independent of older age (p-value=0.004). Adjusted odds ratio for FB impaction in the presence of osteophytes was 4.04. Ventral cervical osteophytes increase the risk for FB impaction in the upper digestive tract. This risk is independent of older age. These findings can be of value in preventive medicine, and emphasize the importance of looking for spinal changes in patients with recurrent FB impaction.