Dysphagia and lung aspiration secondary to anterior cervical osteophytes: a case report and review of the literature.

INTRODUCTION: Two of the most common causes of anterior cervical bony outgrowths are diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). These osteophytes have been associated with serious complications. The objective of this case report is to highlight how commonly occurring anterior cervical osteophytes may become an uncommon cause for life-threatening dysphagia and potential lung aspiration in elderly patients. CASE REPORT: An 80-year-old man came to the hospital with dyspnea and cough productive of sputum. These symptoms were associated with progressive dysphagia for the previous 10 years, which was evaluated with a barium esophagogram that was discontinued due to aspiration of barium. The patient was placed on mechanical ventilation. Neck computed tomography showed anterior cervical osteophytes displacing the upper airway and compressing the esophagus and calcification of the posterior longitudinal ligament with a "bamboo" appearance. The patient underwent surgical removal of the osteophytes. DISCUSSION: The patient had onset of symptoms at > 50 years of age, dysphagia, osteophytes in the clavicle and shoulders, anterior cervical osteophytes, calcified posterior longitudinal ligament, and spinal stenosis, all of which are associated with DISH. AS is associated with the patient's history of stooped posture, anterior displacement of the head while walking, and bamboo spine. The final diagnosis, either DISH or AS, causing these life-threatening anterior cervical osteophytes is undetermined because of the inability to evaluate for the respective diagnostic criteria. However, these osseous pathologies must be considered as causes of life-threatening dysphagia and aspiration in an elderly person.