gms | German Medical Science

Objective: Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition, leading to anterior osteophytic fusion of vertebral bodies of the cervical spine. In rare cases, these osteophytes can cause dysphagia when they impinge on the pharyngoesophageal junction. The aim of this case series was to evaluate surgical treatment for DISH causing dysphagia.

Methods: We present a case series of six patients referred to our clinic for dysphagia with subsequent weight loss caused by osteophytes mainly at the level of C2-C3. In the absence of conservative treatment option resection of the osteophytes was performed through an anterolateral approach. Dysphagia was monitored pre- and postoperatively via fibreoptic endoscopic evaluation of swallowing (FEES) and iodine-contrast swallowing studies. Pre- and postoperative weight was measured as indicator for resolution of dysphagia, as well as subjective patient assessment graded on an ordinal scale.

Results: Median age was 66 years (IQR 63-76); median time between onset of symptoms to surgery was 27.5 months (IQR 19.7-34.5). Median weight loss was 9.25 Kg (IQR:7-16). Two (33%) of patients were even fed through gastric tubes prior to surgery. Median surgery time was 52 minutes (IQR: 47-88), median length of hospital stay was 5 days (IQR: 4-5). No surgical complications occurred, patients reported improved symptoms, FEES showed improvement of swallowing in all cases and both gastric feeding tubes were removed.

Conclusion: DISH is a common disease and can cause a dysphagia in rare cases. Time between onset of symptoms and surgery can be very long in certain cases. Resection of the osteophytes seems to be an adequate treatment option.