Amer Sebaaly1, Ghassan Boubez2, Tarek Sunna3, Zhi Wang2, Elie Alam4, Apostolos Christopoulos5, Daniel Shedid3. 1. Department of Orthopedic Surgery, Centre Hopitalier de l'Université de Montréal, Montréal, Quebec, Canada; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. Electronic address: amersebaaly@hotmail.com. 2. Department of Orthopedic Surgery, Centre Hopitalier de l'Université de Montréal, Montréal, Quebec, Canada. 3. Department of Neurosurgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Quebec, Canada. 4. Otolaryngology Department, University of Miami, Miller School of Medicine, Miami, Florida, USA. 5. Department of Otorhinolaryngology, Centre Hopitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Abstract
BACKGROUND: Diffuse idiopathic hyperostosis (DISH) is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. This disease is mainly asymptomatic but cervical osteophytes can sometimes cause dysphagia (DISHphagia), hoarseness, and even dyspnea. CASE DESCRIPTION: We report, for the first time in the medical literature, a case of a 76-year-old patient with DISH causing an important dysphagia as well as bilateral vocal cord paralysis causing critical dyspnea. The patient was surgically treated by anterior resection of the osteophytes and application of bone wax, with significant clinical improvement and no radiologic recurrence after 2 years of follow-up. DISCUSSION AND CONCLUSION: A thorough literature review didn't yield any article reporting on bilateral vocal cord paralysis caused by DISH. Management of this condition is typically multidisciplinary, and treatment of cervical osteophyte-associated dysphagia or respiratory compromise is primarily medical, after performing necessary tests to rule out other causes of dysphagia. Surgical intervention is warranted when medical treatment fails, when there is weight loss, a significant airway compromise or sleeping alterations. A treatment algorithm is proposed in the end of this review for symptomatic anterior osteophytes caused by DISH in the mobile cervical spine.
BACKGROUND: Diffuse idiopathic hyperostosis (DISH) is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. This disease is mainly asymptomatic but cervical osteophytes can sometimes cause dysphagia (DISHphagia), hoarseness, and even dyspnea. CASE DESCRIPTION: We report, for the first time in the medical literature, a case of a 76-year-old patient with DISH causing an important dysphagia as well as bilateral vocal cord paralysis causing critical dyspnea. The patient was surgically treated by anterior resection of the osteophytes and application of bone wax, with significant clinical improvement and no radiologic recurrence after 2 years of follow-up. DISCUSSION AND CONCLUSION: A thorough literature review didn't yield any article reporting on bilateral vocal cord paralysis caused by DISH. Management of this condition is typically multidisciplinary, and treatment of cervical osteophyte-associated dysphagia or respiratory compromise is primarily medical, after performing necessary tests to rule out other causes of dysphagia. Surgical intervention is warranted when medical treatment fails, when there is weight loss, a significant airway compromise or sleeping alterations. A treatment algorithm is proposed in the end of this review for symptomatic anterior osteophytes caused by DISH in the mobile cervical spine.
Authors: Francesco Maiuri; Luigi Maria Cavallo; Sergio Corvino; Giuseppe Teodonno; Giuseppe Mariniello Journal: J Craniovertebr Junction Spine Date: 2020-11-26