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107
Iranian Journal of Otorhinolaryngology Vol. 22, No.60, Summer-2010, (107-110)
Case Report
Dysphagia Due to Anterior Cervical Spine Osteophyte: A Case Report
*Hossein Mashhadinezhad1, Reza Bagheri2, Mohammad Faraji Rad3,
Ali Mashhadinezhad4
Abstract
Introduction:
Degenerative changes of the cervical spine are more common in elderly, but anterior cervical
osteophytes that cause problems in swallowing are rare. The most common cause of this problem is
DISH disease (diffuse idiopathic skeletal hyperostosis). Trauma is also suggested as a potential cause
in osteophyte formation.
Case Report:
We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by
cervical spine trauma in a car accident 4 years ago, treated with a cervical collar. Dysphagia was the
initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4
level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine
confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and
stomach also ruled out other disorders. Surgical osteophytectomy was performed.
Conclusion:
Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the
literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma.
Keywords:
Cervical spine, Dysphagia, Osteophyte, Trauma
Received date: 10 Jan 2010
Accepted date: 18 May 2010
1Department of neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
2Department of thorasic surgery, Mashhad University of Medical Sciences, Mashhad, Iran
3Department of neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
4Mashhad University of Medical Sciences, Mashhad, Iran
*Corresponding author:
Department of neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
E-mail: mashhadinejadh@mums.ac.ir, Tel:+985118012613, Fax: +985118413492
108
Dysphagia Due to Anterior Cervical Spine Osteophyte Mashhadinejad H, et al
Introduction
Degenerative changes of the cervical spine
usually cause radicular or myelopathy signs
with formation of posterior osteophytes. If an
osteophyte is formed in the anterior portion of
the vertebra, it can cause swallowing
difficulties resulting from extra pressure on the
esophagus or the larynx; it mostly manifests
with dysphagia. Dysphagia due to cervical
osteophytes is a known symptom from many
years ago. Zahn in 1904 described dysphagia
for the first time. Then, two cases of
spondylotic dysphagia were reported in 1926.
Iglauer resected an osteophyte through a
surgical method for the first time. A type of
hyperostosis of the cervical spine with the term
of senile ankylosing hyperostosis was
described in 1950; eventually, it was named
diffuse idiopathic skeletal hyperostosis (DISH,
Forestier’s disease) (1-5).
Case Report
A 52 years old male driver with one-year
history of progressive dysphagia visited our
clinic. He hadn’t been able to eat solid food for
3 months; therefore he was referred to the
hospital. He was healthy in general
examination. The patient had an impact mild
neck deformity due to an accident 4 years ago
that was treated with cervical collar. He had 7
kg loss of weight during this period. Barium
swallow of the patient showed large cervical
osteophyte in C3-C4 level that had put
pressure on larynx (Fig 1).
Fig 1: Shows the stop of barium column in upper
level of osteophyte (with arrow)
CT scan and MRI confirmed the anterior
cervical osteophyte (Fig 2, 3). Esophageal
and gastric endoscopies were normal.
Osteophyte was removed by surgery with
transverse incision on right side of the neck.
The patient used the fluids one day after
surgery and was discharged from the hospital
starting solid food diet 3 days after
operation. Postoperative radiography showed
complete resection of osteophyte (Fig 4). On
one year follow-up after the operation
follow-up showed no problem with
swallowing.
Fig 2: CT scan shows the osteophyte status with
pressure effect on esophagus (white arrow)
Fig 3: MRI shows the anterior osteophyte on C3-
C4 level
Discussion
DISH is the most common cause of
dysphagia due to anterior cervical
osteophytes. The prevalence of this disease is
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Iranian Journal of Otorhinolaryngology Vol. 22, No.60, Summer-2010, (107-110)
5-15% in the elderly (above 60),
that 17-28% of them have this disease along
with dysphagia. However, the cause of this
following is not known (4-6).
Fig4: Cervical x ray after excision of osteophyte
The other causes of skeletal dysphagia that
are presented as case reports are congenital
anomalies, vertebral tumors, anterior disc
hernia; postoperative degenerative changes
and trauma (1-4). Trauma on cervical spine
is suggested as a potential mechanism of
formation the osteophytes. Kissel reported a
43-year-old man with a one year history of
progressive difficulty in swallowing; that he
had a cervical spine injury in a bus accident
two years prior to the onset of symptoms (3).
McGarrah presented a 68-year -old man who
had a 2-year history of progressive
dysphagia due to a cervical spine injury
sustained 40 years earlier resulting from a
jump (7).
Anterior cervical osteophytes can cause
dysphagia in several ways. A large
osteophytes obstructs or deviates esophagus
and larynx. Smaller osteophytes in regions of
larynx that have anatomic limitation
movement (coricoid cartilage and diaphragm
zone) can also cause problem in swallow.
Inflammation of soft tissue continuous
movement of esophagus in contact with
osteophytes is another mechanism (4,5).
Neuromuscular disorders of esophagus,
tumors of esophagus, larynx and lung,
mediastinum, gastroesophageal reflux Zenker
diverticulums Plummer-Vinson's syndrome
should be considered for differential
diagnosis of the patients with problems in
swallow. Since anterior cervical osteophyte is
a rare cause of dysphagia, neck radiography
should be performed to assess it. If there is
osteophyte, barium swallowing or video
fluoroscopic study of the esophagus rules out
other disorders. CT scan of the cervical spine
and MRI not only show the position of
osteophyte, but also show the relation
between esophagus and cervical spine and
expansion of lesion (1-5). Dysphagia
originating from an anterior cervical
osteophyte especially with mild symptoms is
treated medically and administration of
nonsteroidal anti inflammatory drugs
muscular relaxants steroid therapy and anti
reflux drugs are suggested in addition to
modifying the patient's diet. Surgical
osteophytectomy is recommended if
dysphagia is severe or if the patient does not
improve with medical treatment. The
surgical technique is extra esophageal and
performed in an anterolatral approach of the
neck. Postoperative cervical radiography
confirm its resection (4,5,8). Surgical
osteophytectomy is the most effective
method in these patients. It is reported that
among 30 patients with an osteophyte whom
underwent surgery, 28 cases improved
promptly after surgery and 2 cases showed a
delayed improvement. Oppenlander
performed surgery on 9 patients with
osteophyte where all cases improved after
the operation. McCafferty reported that the
cause of delayed improvement is persistent
inflammation or fibrosis of the esophagus.
Surgical complications including temporary
paralysis of the recurrent laryngeal nerve,
esophageal fistula, hematoma and
infection rarely occur (5-9).
Conclusion
Degenerative changes of cervical vertebra
can cause dysphagia with formation of
osteophytes. Cervical osteophyte is a rare
cause of dysphagia and trauma is the
potential mechanism in osteophyte
110
Dysphagia Due to Anterior Cervical Spine Osteophyte Mashhadinejad H, et al
formation, cervical spine radiography should
be performed for diagnosis of dysphagia.
Conservative therapeutic methods or
resection by surgery are recommended in
cases which the presence of an osteophyte is
confirmed.
Acknowledgment
The authors wish to thank the
gastroenterologist, Dr. Moradi Moghadam
for her invaluable assistance in performing
upper gastrointestinal endoscopy.
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