Swallowing difficulties in diffuse idiopathic skeletal hyperostosis

Czech version

Authors: I. Štětkářová ¹; J. Chrobok ²
Authors‘ workplace: Neurologické oddělení Nemocnice Na Homolce, Roentgenova , Praha ¹; Neurochirurgické oddělení Nemocnice Na Homolce, Roentgenova 2, Praha ²
Published in: Cesk Slov Neurol N 2007; 70/103(4): 435-440
Category: Case Report

Práce byla podpořena grantem IGA NR/7773-3

Overview

Objective:
Diffuse idiopathic skeletal hyperostosis (DISH, Forestier's disease, ankylosing hyperostosis) can manifest as large anterior osteophytes in the cervical spine region. Clinical symptoms are often mild, taking the form of unspecified local pain and blockades in the cervical spine. Swallowing or phonation difficulties are rather rare. If also massive posterior osteophytes are present, they can compress the nerve roots or the spinal cord. The article describes the diagnosing and surgical treatment of anterior osteophytes which can cause swallowing disturbances.

Method:
We report 4 patients with swallowing disturbance as the dominant symptom. Two patients reported difficulty in swallowing of solid food, one patient had local spasms and pains in the front part of the neck in addition to the above problems. One patient suffered from compression of nerve structures due to osteoproductive changes and instability of the cervical spine in addition to swallowing difficulties. An X-ray examination of the cervical spine and of the act of swallowing and a CT examination of the neck were performed in each patient. Spinal cord compression was ascertained by means of magnetic resonance imaging (MRI) of the spine and complementary electrophysiological examinations were performed (EMG, somatosensory and motor evoked potentials) in one patient.

Results:
Dramatic relief after the ablation of osteophytes was observed in all the patients. In one of the patients, a dramatic post-surgical improvement of the neurological disorder was observed in addition to decompression of the nerve structures.

Conclusion:
Compression of the oesophagus and trachea by anterior osteophytes should be taken into consideration in differential diagnosing of swallowing and phonation difficulties. X-ray examination of the act of swallowing and CT examination of the neck are important. In spite the risk involved in the surgery (e.g. perforation of the oesophagus), ablation of anterior osteophytes brings immediate relief. In case of clinical symptoms of spinal cord or root compression, also decompression of nerve structures should be performed.

Key words:
DISH – M. Forestier – anterior osteophytes – swallowing difficulties

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