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Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis


Although cervical anterior osteophytes accompanying diffuse idiopathic skeletal hyperostosis (DISH) are generally asymptomatic, large osteophytes sometimes cause swallowing disorders. Surgical resection of the osteophyte has been reported to be an effective treatment; however, little study has been given to the recurrences of osteophytes. A prospective study was performed for seven patients who underwent surgical resection of cervical anterior osteophytes for the treatment of recalcitrant dysphagia caused by osteophytes that accompanied DISH. The seven patients were six men and one woman ranging in age from 55 to 78 years (mean age = 65 years). After a mean postoperative follow-up period of 9 years (range: 6–13 years), surgical outcomes were evaluated by symptom severity and plain radiographs of the cervical spine. On all operated intervertebral segments, the effect of postoperative intervertebral mobility (range of movement >1 degree) on the incidence of recurrent osteophytic formation (width >2 mm) was analyzed by Fisher’s exact test. Complete relief of the dysphagia was obtained within one month postoperatively in five patients, while it was delayed for 3 months in two patients. All of the patients developed recurrent cervical osteophytic formation, with an average increase rate of approximately 1 mm/year following surgical resection. Of the 20 operated intervertebral segments, the incidence of recurrent osteophytes was significantly higher (P = 0.0013) in the 16 segments with mobility than in the four segments without mobility. Five of the seven patients remained asymptomatic, although radiological recurrence of osteophytes was seen at the final follow-up. The two remaining patients complained of moderate dysphagia 10 and 11 years after surgery, respectively; one of these two required re-operation due to progressive dysphagia 11 years postoperatively. In patients with cervical DISH and dysphagia, surgical resection of osteophytes resulted in a high likelihood of the recurrence of osteophytes. Therefore, attending surgeons should continue to follow these patients postoperatively for more than 10 years in order to assess the regrowth of osteophytes that may contribute to recurrent symptoms.

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  1. Akhtar S, O’flynn PE, Kelly A et al (2000) The management of dysphagia in skeletal hyperostosis. J Laryngol Otol 114:154–157

    Article  CAS  PubMed  Google Scholar 

  2. Forestier J, Rotes-Querol J (1950) Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9:321–330

    Article  CAS  PubMed  Google Scholar 

  3. Hirano H, Suzuki H, Sakakibara T et al (1982) Dysphagia due to hypertrophic cervical osteophytes. Clin Orthop 167:168–172

    PubMed  Google Scholar 

  4. Karlins NL, Yagan R (1991) Dyspnea and hoarseness. A complication of diffuse idiopathic skeletal hyperostosis. Spine 16:235–237

    CAS  PubMed  Google Scholar 

  5. Lambert JR, Tepperman PS, Jimenez J et al (1981) Cervical spine disease and dysphagia. Four new cases and a review of the literature. Am J Gastroenterol 76:35–40

    CAS  PubMed  Google Scholar 

  6. Maiuri F, Stella L, Sardo L et al (2002) Dysphagia and dyspnea due to an anterior cervical osteophyte. Arch Orhtop Trauma Surg 122:245–247

    Article  Google Scholar 

  7. McCafferty RR, Harrison MJ, Tamas LB et al (1995) Ossification of the anterior longitudinal ligament and Forestier’s disease: an analysis of seven cases. J Neurosurg 83:13–17

    Article  CAS  PubMed  Google Scholar 

  8. Mosher HP (1926) Exostoses of the cervical vertebrae as a cause for difficulty in swallowing. Laryngoscope 36:181–182

    Article  Google Scholar 

  9. Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119:559–568

    CAS  PubMed  Google Scholar 

  10. Resnick D, Niwayama G (1988) Diffuse idiopathic skeletal hyperostosis (DISH): ankylosing hyperostosis of Forestier and Rotes-Querol. In: Resnick D, Niwayama G (eds) Diagnosis of bone and joint disorders. WB Saunders, Philadelphia, pp 1562–1602

    Google Scholar 

  11. Seidler TO, Pèrez Àlvarez JC, Wonneberger K et al (2009) Dysphagia caused by ventral osteophytes of the cervical spine: clinical and radiographic findings. Eur Arch Oto-Rhino-Laryngol 266:285–291

    Article  CAS  Google Scholar 

  12. Strasser G, Schima W, Schober E et al (2000) Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration. AJR 174:449–453

    CAS  PubMed  Google Scholar 

  13. Stuart D (1989) Dysphagia due to cervical osteophytes. A description of five patients and a review of the literature. Int Orthop 13:95–99

    Article  CAS  PubMed  Google Scholar 

  14. Suzuki K, Ishida Y, Ohmori K (1991) Long term follow-up of diffuse idiopathic skeletal hyperostosis in the cervical spine. Analysis of progression of ossification. Neuroradiology 33:427–431

    Article  CAS  PubMed  Google Scholar 

  15. Umerah BC, Mukherjee BK, Ibekwe O (1981) Cervical spondylosis and dysphagia. J Laryngol Otol 95:1179–1183

    Article  CAS  PubMed  Google Scholar 

  16. Utsinger PD (1992) Diffuse idiopathic skeletal hyperostosis (DISH, ankylosing spinal hyperostosis). In: Moskowitz RW (ed) Osteoarthritis: diagnosis and medical/surgical management. WB Saunders, Philadelphia, pp 355–365

    Google Scholar 

  17. Vielpeau C, Joubert JM, Hulet C (1999) Naproxen in the prevention of heterotopic ossification after total hip replacement. Clin Orthop Relat Res 369:279–288

    Article  PubMed  Google Scholar 

  18. Weinshel SS, Maiman DJ, Mueller WM (1989) Dysphagia associated with cervical spine disorders: pathological relationship? J Spinal Disord 1:312–316

    Google Scholar 

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We thank Dr. Fuminari Kuze, Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan, for his contributions regarding the evaluation of swallowing disorders.

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Correspondence to Kei Miyamoto.

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Miyamoto, K., Sugiyama, S., Hosoe, H. et al. Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis. Eur Spine J 18, 1652–1658 (2009).

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  • Dysphagia
  • Diffuse idiopathic skeletal hyperostosis
  • Cervical spine
  • Osteophyte
  • Recurrence