Volume VI, Number 1 | March 2022

Anterior Cervical Osteophytes as a Cause of Dysphagia: A Case Report

1Kamson A, 1Parekh S, 2Lehane K, 3Peppelman W
1UPMC Pinnacle, Harrisburg, PA, United States; 2Philadelphia College of Osteopathic Medicine – GA Campus, Suwanee, Georgia, United States; 3UPMC – Arlington Orthopedics, Harrisburg, PA, United States

Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory systemic condition characterized by calcification and ossification of tendons, ligaments, and entheses of the axial and peripheral skeleton. The disorder predominantly affects males and increases in prevalence with aging. The anterior spine is commonly affected, often involving the anterior longitudinal ligament and sparing the intervertebral disk. Ossification and the eventual formation of osteophytes can lead to multiple clinical manifestations including decreased range of motion, radiculopathy, myelopathy, and dysphonia. Dysphagia is a rare manifestation of the disease presenting in approximately 0.1% to 4% of cases. Operative intervention is commonly accomplished via osteophytectomy through an anterior approach to the cervical spine. We present a case where a patient underwent surgical intervention for dysphagia after failing extensive medical modalities.

Methods: An 84-year-old male presented to the medical service with shortness of breath and dysphagia to solid and liquids. Past medical history was significant for GERD, chronic kidney disease, hypertension, hyperlipidemia, and a hiatal hernia. He had been previously hospitalized for dysphagia, with less severity. He had undergone multiple EGD’s and dilations, with decreased symptom resolution from each procedure. A barium swallow demonstrated esophageal impingement by osteophytes, most significantly at C4-5. Computed tomography obtained during prior hospitalizations demonstrated increasing osteophytes. Due to the chronicity of his symptoms, failure to significantly improve after GI interventions, and imaging demonstrating esophageal impingement, it was determined that he would likely benefit from surgical intervention. He underwent a C3-6 osteophytectomy with partial C3-6 corpectomies. Resection of anterior osteophytes required burring approximately 3 cm of bone to reach each vertebral body at their corresponding levels.

Results: At six months postoperatively, he was tolerating a regular diet with complete resolution of symptoms. Imaging at that time demonstrated no signs of aspiration or dysphagia.

Conclusion: DISH as a cause of dysphagia remains a rare occurrence. It is important to undergo a thorough workup by a gastroenterologist or otorhinolaryngologist prior to considering surgical intervention. Patients that are deemed appropriate surgical candidates may benefit from an osteophytectomy; however there is always a risk of symptom recurrence. The utilization of a multidisciplinary approach that includes speech and diet therapy is essential to maintaining adequate nutrition and symptom relief.

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The Journal of the American Osteopathic Academy of Orthopedics

Steven J. Heithoff, DO, FAOAO

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Authors in This Edition

J. Michael Anderson BS, OMS IV
Rigel Bacani BA, BS, OMS II
David Beckett OMS I
Bhakti Chavan MBBS, MPH
Jake Checketts DO
Grant Chudik OMS II
Adam Dann
Marc Davidson MD
Clinton J. Devin MD
Jeffrey Dulik DO
Bryan Dunford BS, OMS II
Diego Galindo DO
Gregory Galvin DO
Curtis Goltz DO

Jordan Grilliot DO
Brian Handal
Safet Hatic
Scott Dean Hodges DO
David Houserman DO
Jenna Jarrell MS IV
Michael Jones DO
Anthony Kamson DO
Tyler Metcalf MS IV
Anna Elisa Muzio DO
Cesar Cornejo Ochoa OMS I
Brandi Palmer MS
Joseph Patrick
David Phillips DO

Jonathan Phillips MD
Kornelis Poelstra MD
Jesse Raszewski DO, MS
Katherine Sage DO
Steven Santanello DO, FAOAO
Jared Scott DO
Julieanne Sees
James Seymour DO
Jonathan Schneider DO
John Alex Sielatycki MD
Benjamin Taylor MD, FAAOS
Trevor Torgerson BS, OMS IV
Phong Truong DO
Matt Vassar PhD