Management of respiratory compromise caused by cervical osteophytes: a case report and review of the literature

Abstract

Background context: Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH is associated with large anterior osteophytes of the cervical spine, which can cause complications by compressing adjoining structures. Dysphagia is reported in up to 28% of patients, but respiratory compromise is rare. There have been no published recommendations for treatment. Purpose: To report that resection of cervical osteophytes, without cervical fusion, can be successful in the treatment of severe respiratory distress. Study design: This report describes the management of a patient with DISH and severe respiratory distress resulting from large anterior cervical osteophytes. Methods: A team approach was used with collaboration between the orthopedic spine surgeons and the otolaryngologists. Results: This patient was found to have compression of her posterior pharyngeal wall by the osteophytes. Tracheostomy was required for the management of the airway. The patient was dependent on the tracheostomy until the osteophytes were resected. The patient was then able to breathe normally. Treatment recommendations were developed based on this case of osteophyte-induced respiratory compromise as well as the previously published accounts of osteophyte-induced dysphagia. Conclusions: Airway obstruction resulting from DISH can be treated according to the same principles as dysphagia resulting from DISH: surgical excision of osteophytes if conservative support fails.