Cervical osteoarthropathy: an unusual cause of dysphagia

Abstract

Presentation: a 72-year-old man complained of progressive dysphagia for solids associated with a sensation of foreign body in his throat for 2 years. A barium swallow showed a bridging osteophyte between C4 and C5 vertebrae indenting the oesophagus posteriorly and displacing it anteriorly. Outcome: he refused surgical intervention and was given dietary advice. After 6 months, his weight was steady and he was able to swallow semi-solid food without difficulty.

Diffuse Idiopathic Skeletal Hyperostosis causing Dysphagia due to a Giant Cervical Osteophyte: A Case Report

“…The possible mechanism of dysphagia is mostly mechanical compression to esophagus. However pharyngo-esophageal irritation, which induces peri-esophageal edema, inflammation, and a local inflammatory reaction resulting in cricopharyngeal spasm and esophageal denervation, have also been suggested (7,8,12) .…”

“…Although rare, patients with anterior cervical osteophytes may complain of dysphagia particularly when the osteophytes are extraordinarily large (5) . Also, various local structural lesions such as oropharyngeal tumors, vascular pathologies, retropharyngeal abscesses, and anterior cervical osteophytes may lead to mechanical esophageal dysphagia (1,5,12,15) .…”

An unusual cause of cervical dysphagia

“…Barium Swallow showing a prominent osteophyte at C5/C6 level impinging on the cervical oesophagus (White arrow) pharyngeal fistulae or obstructive sleep apnoea. [2] The causes of hypertrophic anterior cervical osteophytes include cervical spondylosis, diffuse hypertrophic spinal hyperostosis (DISH), ankylosing spondylitis, inter-vertebral disc degeneration, trauma and infection [3]. Cervical osteophytes are present in up to 20-30% of the elderly population but do not usually cause symptoms.…”

“…Oesophagoscopy is required to exclude intrinsic lesions but should be performed with care in view of the risk of perforation. It is always important to exclude more sinister causes, like cancer, before attributing the cause of dysphagia to osteophytes [3].…”

“…Milder dysphagia may be managed conservatively with non-steroidal antiinflammatory drugs (NSAIDS), dietary modification and observation [3]. In patients unable to tolerate oral NSAIDS, because of swallowing difficulty, phonophoresis involving transdermal NSAID delivery enhanced by ultrasound appears effective [5].…”