Large Anterior Cervical Osteophytes Research Articles

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.

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.

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)

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>

Giant anterior cervical osteophyte leading to Dysphagia.

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.

Anterior Cervical Osteophytes Causing Dysphagia and Dyspnea: An Uncommon Entity Revisited

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscopy. Surgical removal of all osteophytes led to the resolution of symptoms. Dyspnea with or without dysphagia caused by hypertrophic anterior cervical osteophytes is an uncommon entity. The exhaustive diagnostic workup proposed in the literature could be simplified by using fiberoptic laryngoscopy and dynamic videofluoroscopy. The causes, treatment, and outcome are discussed.

Mechanical Dysphagia Due to Cervical Osteophytes in a Young Female

Purpose: Disruption of transport of liquid or a fluid bolus along the pharyngo-esophageal path by mechanical obstruction or a neuromuscular dysfunction leads to symptomatic dysphagia. Dysphagia can occur at the oropharyngeal or esophageal level. The most commonly reported etiologies of dysphagia include strictures, webs, malignancies and esophageal spasm. Cervical osteophytes are rarely known to cause dysphagia by mechanical obstruction in the elderly. We report a rare presentation of symptomatic dysphagia in a young female due to impingement by a cervical osteophyte. Methods: A 43 year old African American female with history of asthma and carpal tunnel syndrome presented with a two year history of worsening dysphagia initially to solids that progressed to both solids and liquids. She denied any odynophagia, globus sensation, weight loss, abdominal pain, hematemesis, nausea, or vomiting. There was no history of reflux disease, chemical ingestion, strictures or recent use of medications. Physical exam was unremarkable and laboratory studies were unrevealing. Rigid endoscopy did not reveal any oropharyngeal abnormalities. Barium swallow revealed significant posterior compression of the esophageal wall by several large anterior cervical osteophytes at the C5-6 and C6-7 level. There was no evidence of strictures, mucosal ulceration or neuromuscular dysfunction. MRI of the spine revealed significant degenerative changes in the cervical vertebrae with posterior impingement of the esophageal wall by osteophytes. Anatomical obstruction by the protruding osteophytes caused significant narrowing of the esophageal conduit explaining our patient's dysphagia. She was scheduled for surgical excision of the osteophytes. Conclusions: Asymptomatic osteophytes of the anterior margins of the cervical spine may occur in 20–30% of the population. Larger osteophytes have been reported to cause, odynophagia, otalgia, and globus sensation in addition to dysphagia especially in the elderly. The young age at presentation makes our case unique. Extrinsic compression by osteophytes should be considered during the evaluation and workup of a patient with dysphagia. [figure 1]Figure 1

Cervical osteophytes: a cause of potentially life-threatening laryngeal spasms

This 80-year-old woman presented with acute breathing difficulty during neck flexion when cyanosis also developed. The only potential causes were detected on cervical magnetic resonance imaging: two large anterior cervical osteophytes compressing the retropharyngeal space. Excision of these osteophytes resulted in resolution of the symptoms.

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

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.

Dysphagia due to cervical osteophytes

A case of a 64-year-old man is presented with painless dysphagia and loud noise on swallowing due to large anterior cervical osteophytes demonstrated on plain radiographs and magnetic resonance imaging accompanied by a brief review of the literature.