Diffuse idiopathic skeletal hyperostosis as a cause of progressive dysphagia: a case report

BACKGROUND: Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is an idiopathic rheumatological abnormality in which exuberant ossification occurs along throughout the body, but most notably the anterior longitudinal ligament of the spine. CASE PRESENTATION: We report on a 75-year-old white patient with progressive difficulty in swallowing and dysphagia, resulting in weight loss over the last two years. Radiological evaluation, (x-rays and Magnetic resonance imaging), confirmed the diagnosis of DISH, and revealed marked compression of the esophagus at the C5-6 level, due to excessive ossification of the anterior longitudinal ligament of the cervical spine. The patient was treated with anterior cervical approach for removal of the hyperostosis without fusion. He had marked improvement in swallowing function and was able to resume a normal diet after one month. CONCLUSION: Diffuse idiopathic skeletal hyperostosis or Forestier's disease is an uncommon etiology of difficulty in swallowing and progressive dysphagia. Surgical excision of the cervical osteophytes typically leads to excellent symptomatic results.