Upper dysphagia in patient with diffuse idiopathic skeletal hyperostosis

Overview

Diffuse idiopathic skeletal hyperostosis (DISH) is a chronic systemic skeletal disorder of unknown etiology characterized by massive bone calcifications and ligament ossifications, particularly in the area of anterior longitudinal ligament. Dysphagia, resulting from the pressure exerted by cervical column ossifications to the oesophagus, is rarely diagnosed as a first symptom of the disease. We present a case of a 69-year old patient in whom the first dominant manifestation of the disease was upper dysphagia developed in the course of 3 years when the patient experienced difficulties in swallowing, choking sensations and coughing when eating. He complained about intermittent pain in the cervical and later in the lumbar portion of the vertebral column during the last 10 years. However, he has not gone to a doctor until the dysphagia occurred because he considered that the pain intensity was not too high. For increased manifestation of swallowing disorder he was examined by an othorhinolaryngologist who did not found any pathology. Afterwards gastroduodenoscopy has been attempted. However, the fiberscope did not pass further than behind the tongue. The CT scan showed clear oppressive changes of the oesophagus due to serious degenerative changes of the cervical vertebral column. X-ray of the cervical, thoracic and lumbar vertebral columns showed massive diffuse ossification of the entire spine corresponding with the symptoms of diffuse idiopathic skeletal hyperostosis. Magnetic resonance imaging (MRI) then confirmed the diffuse ossification and massive C6/7 and C7/Th1 osteophytes causing clear impressions to the dorsal oesophagus contour. Surgery of the cervical vertebral column using the anterior approach was performed in order to remove the exostoses from the anterior part of the cervical vertebral column. After the surgery dysphagic disorders disappeared. It is a first published case report of such disorder in the Czech Republic, when cervical spine surgery was performed because of patient´s dysphagia.

Key words:
diffuse idiopathic skeletal hyperostosis, upper type dysphagia