How to diagnose and treat symptomatic anterior cervical osteophytes?

Abstract

Forestier disease, a cervical anterior form of diffuse idiopathic skeletal hyperostosis (DISH) is electively diagnosed in the elderly population. ENT symptoms are likely prevalent (dysphagia, and less frequently dysphonia, dyspnea, etc.), but diagnosis and the relation between symptoms and anterior longitudinal ligament ossification can be difficult to demonstrate. Starting from two clinical cases and a review of the literature, the authors propose a diagnostic and therapeutic course of action. A typical description of Forestier disease is related based on the cases of two 80- and 79-year-old men referred with gradually worsening swallowing problems leading to dysphagia. Both underwent surgical resection of cervical osteophytes via a lateral cervical approach after failure of the medical treatments. Based on the clinical presentations and the analysis of the literature, the authors describe the clinical features of the cervical anterior form of DISH presenting with ENT symptoms. The diagnosis and conservative therapeutic, and surgical management of anterior cervical hyperostosis based on ongoing gradual solutions are described.