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Surgical Treatment for Cervical Diffuse Idiopathic Skeletal Hyperostosis as a Cause of Dysphagia

INTRODUCTION: The majority of diffuse idiopathic skeletal hyperostosis (DISH) involving the anterior margin of the cervical vertebrae is asymptomatic, but it can cause dysphagia. Improvements in swallowing after surgical treatment have been reported in several case series. However, the appropriate a...

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Detalles Bibliográficos
Autores principales: Yoshioka, Katsuhito, Murakami, Hideki, Demura, Satoru, Kato, Satoshi, Yonezawa, Noritaka, Takahashi, Naoki, Shimizu, Takaki, Tsuchiya, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Spine Surgery and Related Research 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698526/
https://www.ncbi.nlm.nih.gov/pubmed/31440668
http://dx.doi.org/10.22603/ssrr.2017-0045
Descripción
Sumario:INTRODUCTION: The majority of diffuse idiopathic skeletal hyperostosis (DISH) involving the anterior margin of the cervical vertebrae is asymptomatic, but it can cause dysphagia. Improvements in swallowing after surgical treatment have been reported in several case series. However, the appropriate amount of osteophyte resection for this disease in terms of the pathophysiology of dysphagia is still unknown. The current report describes the appropriate surgical procedure for dysphagia secondary to anterior cervical hyperostosis, and discusses the etiology of dysphagia. METHODS: This is a retrospective review of four patients who presented with complaints of dysphagia secondary to anterior cervical hyperostosis. All patients underwent videofluoroscopic esophagrams (VFEs) to identify the specific region associated with the dysphagia. Esophageal obstruction was present at C3-4 in two patients and at C4-5 in two patients. Three patients underwent localized and limited resection of the anterior cervical osteophytes. One patient underwent total resection of the anterior cervical osteophytes, because re-ossification had occurred after a previous resection. RESULTS: Postoperative VFE demonstrated an improvement in swallowing in the three patients who underwent limited resection of the osteophytes. The patient who underwent total resection of the osteophytes did not experience a full recovery of normal swallowing function. We concluded that the dysphagia was caused by both osteophyte obstruction and neuropathy resulting from the previous surgery or inflammation secondary to osteophyte irritation. CONCLUSIONS: Localized and limited resection of anterior cervical osteophytes is recommended and should be considered for patients with dysphagia from anterior cervical hyperostosis.