Anterior Cervical Osteophytes Research Articles

Isolated Unilateral Hypoglossal Nerve Palsy in a Man with Anterior Cervical Osteophyte (P9-4.008)

Isolated Unilateral Hypoglossal Nerve Palsy in a Man with Anterior Cervical Osteophyte (P9-4.008)

Oropharyngeal Dysphagia & Aspiration in a 63-Year-Old Man- A Case Report

Introduction: Dysphagia due to nonmalignant causes is not an uncommon occurrence in patients over the age of 60. Males are more affected than the females. It can be associated with significant morbidity and mortality especially as it increases the risk for malnutrition, and pneumonias due to aspiration etc. Case Presentation: We present this rare case of worsening dysphagia and episodes of choking in a 63year old male due to large anterior cervical osteophytes. X-ray and flexible laryngoscopy revealed a large bulge over the posterior pharyngeal wall in the midline. Conclusion: Dysphagia in the elderly can lead to increased morbidity and life-threatening complications. Anterior osteophytes are found in nearly 20% to30% of the elderly population but rarely cause dysphagia. However, in some cases especially when associated with diffuse idiopathic skeletal hyperostosis (DISH/ Forestier’s disease) and ankylosing spondylitis these can cause severe dysphagia. In many cases of symptomatic anterior osteophytes surgery is considered an ultimate measure to relieve symptoms, decrease mortality, and improve the quality of life. We did a thorough literature search to know the prevalence and management of dysphagia due to anterior osteophytes.

Can Anterior Osteophyte Fractures Be Distinguished From Fracture Mimics in the Subaxial Cervical Spine? A Retrospective Analysis Evaluating Reported Fractures With Clinical Management Correlation.

This study aimed to retrospectively distinguish true- from false-positive fractures of anterior subaxial cervical osteophytes, which were reported on noncontrast computed tomography reports, and to correlate the imaging findings with patient symptoms and analyze the downstream impact on management of both true and false positive fractures. A total of 127 patients had computed tomography reports of anterior osteophyte fractures. Radiology reports and imaging studies were evaluated to distinguish true fractures from fracture mimics. We analyzed imaging features including rigid spine (RS), prevertebral soft tissue swelling (PVSTS), and instability. We categorized symptoms and examination findings into 3 groups (0, asymptomatic; 1, neck pain; 2, neurological symptoms). Management was categorized into 3 groups (0, no treatment; 1, external bracing; 2, surgery). Associations between imaging features, fracture classification, clinical symptoms, magnetic resonance imaging utilization, and management were calculated using χ2 with Cramer V test to determine effect size. Eighty patients had false-positive fractures, and 47 were true positive. There were significant associations between magnetic resonance imaging utilization and fracture classification (P ≤ 0.001), PVSTS (P ≤ 0.005), patient symptoms (P ≤ 0.001), and patient management (P ≤ 0.001). There were significant associations between patient management and fracture classification (P ≤ 0.001), patient symptoms (P ≤ 0.001), PVSTS (P ≤ 0.001), imaging findings of instability (P ≤ 0.001), and RS (P ≤ 0.021). There were significant associations between fracture classification and patient symptoms (P ≤ 0.045), and RS (P ≤ 0.006). Subaxial isolated anterior osteophyte fractures fell into 3 major categories. By our methodology, if a suspected fracture was determined to be a fracture mimic in an asymptomatic patient, it was unlikely to be clinically significant. Isolated anterior osteophyte fractures without neurological symptoms or more concerning imaging findings can be treated conservatively. Finally, fractures that demonstrate indirect signs of instability or are associated with RS are more associated with surgical management.

Enlarged anterior cervical osteophyte presenting with upper airway obstruction

Enlarged anterior cervical osteophyte presenting with upper airway obstruction

S2032 Dysphagia Lusoria: A Rare Case of Progressive Dysphagia

Introduction: Deviations from the classic anatomic configuration of the aortic arch are common. An aberrant right subclavian artery is one known anatomic variant that rarely causes symptoms. Here we describe a case in which a patient presents with progressive dysphagia and is found to have retroesophageal compression due to aberrant right subclavian artery and anterior cervical osteophytes. Case Description/Methods: A 61-year-old female with a medical history of invasive ductal carcinoma of the left breast reports with dysphagia and odynophagia for one year. Initially her symptoms began with solids, but then progressed to liquids. Patient underwent CT soft tissue neck which showed an aberrant right subclavian artery compressing the posterior aspect of the esophagus near the level of the thoracic inlet as well as cervical anterior osteophytes leading to compression of the esophagus at the upper cervical aspect. She underwent barium Esophagram which also showed indentation in the posterior esophagus which was later directly confirmed by EGD. At this time, patient has been referred to vascular surgery for further management. Discussion: Aberrant right subclavian artery, or arteria lusoria, is one of the most common abnormalities of the aortic arch. The aortic arch usually branches off into the left subclavian artery, the left common carotid artery, and the brachiocephalic artery which further branches into the right common carotid and right subclavian artery. When arteria lusoria is present, the brachiocephalic artery is absent, and the right common carotid artery and right subclavian artery originate directly from the aortic arch with the latter having a distal left sided origin. Rarely, this anatomic variant can lead to compression of the esophagus and produce a condition known as dysphagia lusoria which was first described by Dr. David Bayford in 1787 in a woman with long term dysphagia after autopsy, thus it is also known as Bayford-Autenrieth dysphagia. Most patients present with symptoms in middle age or older, with mechanisms such as increased tracheal rigidity and elongation of the aorta theorized. In the case of our patient, anterior cervical osteophytes development may have contributed to symptom onset. A variety of surgical approaches for arteria lusoria are available with surgical or endovascular approaches available.Figure 1.: Imaging of our patient with dysphagia. A) Axial and B) Sagittal images of the CT soft tissue of the neck showing aberrant origin of right subclavian artery (blue bold arrow) with abnormal course behind the esophagus (red curved arrow). C) Barium esophagograms performed demonstrated extrinsic impression upon the cervical esophagus posteriorly (yellow bold arrow) causing dysphagia.

Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review)

Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms "Anterior Cervical Osteophyte," "Diffuse Idiopathic Skeletal Hyperostosis (DISH)," and "Dysphagia" and "Treatment" for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated with DISH in elderly patients (average 65years). The major clinical findings were dysphagia or respiratory compromise, with the most common level of bridging osteophytes of the cervical spine at C3-C5. There were 10 articles on surgical treatment involving anterior cervical osteophytectomy without fusion, 1 for multilevel cervical oblique corpectomy, 1 for anterior cervical discectomy with fusion plus plate, and 1 for anterior cervical osteophytectomy with stand-alone PEEK cage or plus plate. All the cases resulted in significant improvement without recurrence, with only 1 case having post-operative complications. Follow-up duration was 3-70.3months. Conclusions: Surgical intervention for anterior cervical osteophytectomy appears to result in improved outcomes. However, there could be disadvantages concerning cervical spine motion if cervical osteophytectomy with cervical discectomy and fusion (ACDF) plus plate system is done.

Dysphagia in a patient with ankylosing spondylitis: A case report

BACKGROUNDAnkylosing spondylitis (AS) is a systematic and rheumatic disease, which causes multiple symptoms. However, dysphagia due to the formation of a giant anterior cervical osteophyte is rare in patients with AS.CASE SUMMARYWe present the case of a 65-year-old male patient who was diagnosed with AS and visited the hospital with a complaint of progressive dysphagia. The appropriate imaging examinations indicated that a giant anterior cervical osteo-phyte at C3-4 caused esophageal compression, which led to dysphagia. An operation for resection was performed without complications.CONCLUSIONThis case demonstrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS, and early accurate diagnosis and surgical treat-ment are very important for the improvement of symptoms. Anterior cervical discectomy and fusion are extremely effective and should be taken into consideration.

Impact of Osteophytectomy on Swallowing Function in a Patient with Chronic Dysphagia

Anterior cervical osteophytes are common in the geriatric population. Dysphagia can occur in individuals suffering from these spinal abnormalities. Surgical intervention is an uncommon course of treatment for these patients, but is often utilized as a last resort with the hope of swallow recovery. The purpose of this article is to highlight a unique case study documenting the required treatment course for dysphagia associated with osteophytes and subsequent osteophytectomy. We review current literature of both conservative and surgical interventions, as well as discuss the rehabilitation course for a complex patient with persistent dysphagia. Various outcome measures were utilized during the patient’s inpatient stay to track progress including the Functional Oral Intake Scale (FOIS), the Bolus Residue Scale (BRS), Penetration Aspiration Scale (PenAsp), Dysphagia Outcome Severity Scale (DOSS), and a Modified Barium Swallow Study (MBSS). The patient received rehabilitative training including oral motor and pharyngeal strengthening exercises, respiratory strengthening, speech instruction, cognitive retraining, and instrumental assessment. Following osteophytectomy and dysphagia rehabilitation the patient did not show any change based on a repeat MBSS which revealed the necessity for the patient to remain nothing per oral (NPO). The patient demonstrated an inability to manage his secretions, requiring continual suctioning. Upon discharge the patient remained NPO with the exception of ice chips, utilized a PEG for nutrition, and had a red capped tracheostomy. He was on room air and independently utilized oral suction as needed for secretion management. Our patient’s clinical course was not aligned with typical osteophytectomy recovery as progress after his 25-day inpatient stay was limited. The goal of this case study is to contribute information to the limited and variable data available regarding treatment options, outcome measures and timelines for recovery as it pertains to patients who undergo an osteophytectomy.

S1902 Video Swallow Study and Neck CT Reveals the Rare Association of Diffuse Idiopathic Skeletal Hyperostosis With Oropharyngeal Dysphagia

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by non-inflammatory ossification of ligamentous tissue. While the disease is not uncommon, cervical involvement is rare, and oropharyngeal obstruction as a presenting symptom is even more infrequent. An existing diagnosis of DISH or previous radiographic evidence of the process should be high on the differential when evaluating for new or progressive dysphagia. CASE DESCRIPTION/METHODS: An 82-year-old male with a history of cervicalgia was evaluated for six months of solid food dysphagia. During this period he endorsed an unintentional 15 lb weight loss. Outside of his cervicalgia, a full review of systems was negative other than a mild benign tremor. Initial evaluation of dysphagia by endoscopy was unremarkable. A head/neck CT was obtained, with referral to speech pathology for a video-fluoroscopic swallow study which revealed osteophytes at C3-C4 and C5-C6, with impaired bolus transfer. Both ENT and neurosurgery were consulted. Given his dysphagia he underwent surgery for C3 through C7 osteophyte resection. At a 6-month follow-up, he endorsed a near complete resolution of cervicalgia and dysphagia. DISCUSSION: Cervical osteophytes are a known cause of oropharyngeal dysphagia, causing obstruction via anterior displacement of the hypopharynx. Odynophagia due to pressure ulcerations is often a presenting symptom. However, it is atypical for DISH, or Forestier Disease, to present as such. DISH is a disorder of abnormal ossification with a pathogenesis that is not fully understood. While the disease lacks consistent laboratory abnormalities or associated genetic markers, radiologic findings are well established and include ossification of the anterior paravertebral ligaments and peripheral enthuses. The relative risk of dysphagia in DISH is not well established. Typically, a consult to surgery for resection in cases of dysphagia is recommended; but due to the rarity of this presentation, there is limited data on optimal management. As DISH associated musculoskeletal symptoms are typically conservatively managed similarly to mild chronic lower back pain, there is potential for overlooking the disease during evaluation of dysphagia. In patients with cervicalgia or lower back pain, review of previous imaging studies to rule out DISH may be warranted.Figure 1.: Video Fluoroscopic Swallow Study showing impaired transfer corresponding to visible cervical osteophytes, in particular at C3-C6.Figure 2.: Head/Neck CT, Sagittal View Prior to surgical intervention with osteophyte resection.Figure 3.: Head/Neck CT, Sagittal view following C3 through C7 anterior cervical disc osteophyte resection.

Anterior cervical osteophytic “giant beak-like lesion” causing dysphagia

Large anterior cervical osteophytes can occur during degenerative cervical disease, a condition called Diffuse Idiopathic Skeletal Hyperostosis (DISH), which can cause mechanical compression of the pharyngoesophageal area causing dysphagia. Both conditions are very rare. Here we present the case of an 81-year-old male who presented with progressive dysphagia due to a giant beak-like osteophytic lesion anterior to the C3 and C4 vertebral spine causing compression of the pharyngoesophageal segment. The patient declined treatment by anterior cervical osteophytectomy and accepted the possible complications such as progressive dysphagia.

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia.

Study Design:This was a retrospective cohort study.Objectives:When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia.Methods:Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%).Results:Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia (P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications (P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication.Conclusions:Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.

Anterior cervical osteophytes causing dysphagia: Choice of the approach and surgical problems.

Background:Anterior cervical osteophytes (ACOs) may rarely cause dysphagia, dysphonia, and dyspnea. Symptomatic ACOs are most commonly located between C3 and C7, whereas those at higher cervical (C1–C2) levels are rarer. We report a case series of 4 patients and discuss the best surgical approach according to the ostheophyte location and size, mainly for those located at C1–C2, and the related surgical problems.Materials and Methods:Four patients (two males and two females) aged from 57 to 72 years were operated on for ACOs, causing variable dysphagia (and dyspnea with respiratory arrest in one). Three patients with osteophytes between C3 and C5 were approached through antero-lateral cervical approach, and one with a large osteophyte between C1 and C3–C4 level underwent a two-stage transcervical and transoral approach. All had significant postoperative improvement of dysphagia.Results:The patient operated on though the transoral approach experienced postoperative flogosis of the prevertebral tissues and occipital muscles and thrombosis of the right jugular vein and transverse-sigmoid sinuses (Lemierre syndrome).Conclusion:The transoral approach is the best surgical route to resect C1 and C2 ACOs, whereas the endoscopic endonasal approach is not indicated. The anterior transcervical approach is easier to resect osteophytes at C3, as well as those located below C3. A combined transoral and anterior cervical approach may be necessary for multilevel osteophytes.

Dysphagia and Dyspnea Caused by Large Anterior Cervical Osteophyte

Background Data: Unfortunately, large anterior cervical osteophytes are a forgotten cause of dysphagia and dyspnea. They can cause marked change in diet habits or interfere with patients’ daily activities and sleep without significant neck pain or radicular pain. Diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, degenerative changes, and prior trauma including surgery can cause cervical osteophytes. Conservative medical treatment and diet modification may be a useful option when treating these patients; however, surgery may be mandatory, in particular with sever progressive symptoms not responding to conservative measures with excellent results and accepted incidence of complications. Study Design: This is a retrospective clinical case study. Purpose: To highlight this uncommon cause of dyspnea and dysphagia and define the possible management strategies. Patients and Methods: This study was conducted in Mansoura University Hospital on nine patients presented with dysphagia, dyspnea, or both. The cause of their symptoms was large anterior cervical osteophytes. Six patients were males and 3 were females with their age ranged from 53 to 75 years. All patients were assessed by X-ray, CT, and MRI of the cervical spine and underwent fiber optic nasoendoscopy to assess posterior pharyngeal wall and other causes of upper airway obstruction. All patients had a trial of conservative measures including anti-inflammatory, antireflux medication, corticosteroids, diet modification, and consultations with specialists in rheumatology and speech and swallowing therapy. Results: Of the 9 patients, three patients improved on the above-mentioned conservative measures, and one patient who presented with stridor underwent urgent tracheostomy and refused further surgery. Five patients who failed conservative therapy for at least three months underwent surgical excision of their osteophytes through anterior cervical approach. Improvement of surgical group was satisfactory according to the Dysphagia Scoring System. Conclusion: Although large anterior cervical osteophyte is a rare cause of dysphagia and dyspnea, it should be checked and excluded especially in elderly patients. Adequate conservative therapy is a valid effective option; however, surgery in some of these patients may be simple, safe, and effective. (2019ESJ188)

Long-term results after surgical treatment of diffuse idiopathic skeletal hyperostosis (DISH) causing dysphagia

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory, systemic skeletal disease. The associated formation of anterior cervical osteophytes can cause severe dysphagia, so the osteophytes have to be surgically removed. Because the clinical syndrome is rare, long-term outcome after surgical therapy is likewise scarce. In this retrospective, single-center study, five consecutive patients with DISH causing dysphagia and following resection of osteophytes between 2005 and 2015 were included. Patient and surgical reports were evaluated regarding surgery-related and postoperative complications. For the short term, the outpatient visits three months and one year after the surgery were evaluated. For the long-term results, patients were followed via questionnaires concerning actual complaints, complications or further treatment associated to DISH. Five male patients (61.6 years old; range, 43–77) were operated. One patient had a transitory worsening of a preexisting hoarseness and one patient had permanent problems with singing postoperatively. All patients reported improvement of dysphagia after three months. One patient deceased five years after surgery independently of DISH without complaining about recurring dysphagia. After a mean follow-up of 70.3 months (range, 24–126 months), dysphagia was consistently improved in all remaining four patients. The patient with the slightest improvement and clinical deterioration in the course had an initially incomplete resection of osteophytes. Imaging showed a re-increase of ossifications 2.5 years after the surgery. Resection of symptomatic anterior osteophytes in DISH is a safe and promising procedure to improve dysphagia in the long-term, but the recurrence of osteophytes is possible years after initial treatment.

Surgical treatment of anterior cervical osteophytes causing dysphagia.

Dysphagia due to anterior cervical osteophytes is a rare condition. However, it can become serious enough to permanently impair the quality of life up to making normal food intake impossible. If conservative treatment fails, there is the option of surgical resection of the osteophytes. The objective of this study was to assess the outcomes of resections of anterior cervical osteophytes causing spondylogenic dysphagia, taking literature into consideration. Resection of anterior cervical osteophytes using a standard anterior approach was performed in 14 consecutive patients with spondylogenic dysphagia between 2009 and 2015. Indomethacin or radiation was used to prevent recurrence. Imaging and clinical data were collected in follow-up examinations over an average of 50 months. The osteophytes were sufficiently resected in all cases. Anterior plates were placed in three patients due to pronounced segmental mobility. Five patients were given recurrence prevention in the form of indomethacin, nine with radiation. One patient required revision surgery for a hematoma. No other serious complications were observed. All patients had significant improvement of their symptoms. No recurrences or signs of increasing instability were found during the follow-up period. When conservative treatment fails, surgical resection of cervical osteophytes is a sufficient method for treating spondylogenic dysphagia. High patient satisfaction and improvement of the quality of life are achieved with a low complication rate. Routine additional stabilization has been discussed as recurrence prevention. Prophylaxis using indomethacin or radiation, known primarily from hip replacement, also appears to be an option.

Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte.

ObjectiveTo investigate swallowing characteristics of patients with dysphagia caused by anterior cervical osteophytes (ACOs) and compare clinical courses according to treatment options.MethodsA retrospective analysis of 1,866 videofluoroscopic swallowing studies (VFSS) of patients with ACOs from electronic medical records was performed. Patients with other diseases that could explain the dysphagia were excluded. Dysphagia characteristics and severity and clinical and radiological characteristics of subjects with ACOs were evaluated. Dysphagia characteristics and clinical course were compared among three treatment groups: surgical treatment, swallowing rehabilitation, and conservative treatment.ResultsSubjects were 22 men and 1 woman with a mean age of 78.69±8.01 years. The mean osteophyte thickness was 9.07±3.84 mm. It was significantly thicker in the surgical group than that in other groups (p=0.01). ACOs were most frequently found at C5 level. This level also had the thickest osteophytes. However, videofluoroscopic dysphagia scales (VDS) were not significantly different among the three treatment groups. The pharyngeal phase score of the VDS was significantly higher in the surgical group (p=0.041). Dysphagia severity was decreased significantly in the surgical group at 3 months after the initial VFSS (p=0.004).ConclusionThe main swallowing characteristics in patients with ACOs were dysphagia features of the pharyngeal phase, including inappropriate airway protection, decreased laryngeal elevation, and reduced epiglottis inversion. When determining treatment options, it may be helpful to consider dysphagia severity at pharyngeal phase and osteophyte thickness.

An unusual cause of dysphagia in elderly, dysphagia caused by cervical osteophytes: a case report and review of literature

<p class="abstract">Dysphagia may occur in various pathological, inflammatory diseases of esophagus. It may also occur due to motility disorders of esophagus, benign and malignant diseases of mediastinum, cervical spine diseases. Dysphagia secondary to compression of esophagus by a cervical osteophyte is rare. The most common causes of osteophyte (bony outgrowth) in the cervical spine are diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis (AS), and cervical spondylosis. Patients with cervical osteophytes are mostly asymptomatic. Hence, when considering cervical osteophytes as a cause of dysphagia other pathologic entities in the esophagus (e.g. tumors, webs, rings, strictures) should be excluded. We present a 68 year female patient who presented with complaints of dysphagia and neck stiffness since 3 months. She has been evaluated and found that dysphagia is due to large anterior cervical osteophytes compressing pharynx at C2/C3 and esophagus at C5/C6 and C6/C7 vertebral levels respectively. The objective of this case report is to emphasize the importance of anterior cervical osteophyte as a cause of dysphagia in elderly.</p>

Unilateral Head Rotation as an Effective Swallowing Compensation Method in Dysphagia Related to Anterior Cervical Spine Osteophyte

Unilateral Head Rotation as an Effective Swallowing Compensation Method in Dysphagia Related to Anterior Cervical Spine Osteophyte

Unilateral head rotation as an effective swallowing compensation method in dysphagia related to anterior cervical spine osteophyte

Unilateral head rotation as an effective swallowing compensation method in dysphagia related to anterior cervical spine osteophyte

Urgent Anterior Cervical Osteophytectomy for an Asymptomatic Cervical Hyperostosis to Overcome Failed Intubation

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are usually asymptomatic. This is a case report of a patient with massive anterior cervical osteophytes resulting in failure of intubation prior to a lumbar canal stenosis surgery. The osteophytes extended from C3 to C7 and resulted in the anterior displacement of the pharynx and the trachea. The patient was managed successfully with anterior cervical osteophytectomy.