An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease)

Abstract

Stridor is a noisy breathing caused by compromised airway in the larynx and trachea. The causes can either be due to intrinsic or extrinsic compression. Stridor resulting from extrinsic compression due to anterior cervical osteophytes is rare.We report an unusual case of acute stridor due to an osteophytic mass in the cervical vertebrae resulting in a mechanical upper airway obstruction. The underlying pathology was Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH). Stridor is a rare manifestation of DISH and it certainly represents the most lifethreatening one. Only a few cases have been reported in the English literature and are mainly secondary to impaired function of the vocal folds, or postcricoid ulceration and oedema. We present such a case, in that stridor was the result of direct airway obstruction by the osteophytic mass and an emergency tracheostomy had to be performed to establish an airway.

Anterior Cervical Osteophytes Causing Dysphagia and Dyspnea: An Uncommon Entity Revisited

“…Magnetic resonance imaging may reveal inflammatory lesions [2,. Flexible esophagoscopy and bronchoscopy were proposed to evaluate the lower aerodigestive tract [8,15,23,25,26]. Dynamic videofluoroscopy is the main tool for investigating swallowing functions and shows the relationship between swallowing pathology and osteophyte size [31].…”

Diffuse Idiopathic Skeletal Hyperostosis of Cervical Column: a Clinical Anatomy and Functional Approach

“…Obstructions of the upper air way by extrinsic laryngeal constriction has been associated to ossification of the ALL in patients with DISH (Papakostas et al;Caminos et al, 2008), where tracheotomy is continually required during emergency care of patients with respiratory distress due to laryngeal edema (Karkas et al, 2008).…”

“…The clinical consequences in subjects with compromised cervical region of the spinal column frequently manifest progressively increasing cervicalgia; excessive ossification formation of the anterior longitudinal ligament (ALL) can generate dysphagia (Oppenlander et al, 2009), stridor (Papakostas et al, 1999), diminished range of motion (ROM) associated to ankylosis and cervical myelopathy (Mader, 2002).…”

Boyun ağrısı ve disfaji ile seyreden Forestier hastalığı

“…Hastalarda solunum problemleri görülebilir. [8,9] Servikal vertebralarda osteofit ve kalsifikasyon oluflumuna ba¤l› hipofaringeal bölgede darl›k oluflur, hastalarda orotrakeal entübasyon güçlü¤ü görülebilir ve trakeatomi aç›lmas› gerekebilir. ‹kinci olgumuzda KOAH alevlenmesi nedeniyle yo¤un bak›ma al›nan hastan›n O2 satüras-yonlar›n›n düflmesi ve genel durumunun bozulmas› nedeniyle orotrakeal entübasyon denendi.…”