Clinical evaluation of surgery for osteophyte-associated dysphagia using the functional outcome swallowing scale

Abstract

PurposeTo investigate the surgical outcome of patients with osteophyte-associated dysphagia (OAD) using the functional outcome swallowing scale (FOSS).MethodsA retrospective chart review of 10 surgical cases of OAD (9 male and 1 female patient; mean age of 65 years) from 1982 to 2017 was performed, and radiographic evaluations were conducted by video fluoroscopic swallow study (VFSS) and conventional radiography. All OAD cases were treated at a single institution, and osteophytes were surgically resected by the anterior approach under gentle retraction of the affected esophagus. FOSS (0 for normal, 5 for worst) was used for clinical evaluations, and surgical complications were recorded.ResultsVFSS evaluation of OAD showed that the affected osteophyte was located at C4/5 in four patients, followed by C3/4 in three patients. The mean FOSS showed significant improvement from 2.5 preoperatively to 0.3 postoperatively, and no major surgical complications were recorded. Comorbidities were diabetes mellitus in four patients, ossification of the posterior longitudinal ligament in three patients, and lumbar spinal stenosis (LSS) in three patients.ConclusionSurgical treatment of OAD was promising, and all patients showed clinical recovery. Evaluation of dysphagia using FOSS was easy and reliable for OAD management, and FOSS 2 might be a good indication for surgical intervention.

Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review

“…Our previous review identified 12 patients with osteophyte recurrence. Currently, we reported 12 patients with recurrent dysphagia, including regrowth of osteophytes in 5 patients, remarkably after a period of 9 years following surgery [99].…”

Disfagia por osteofitose cervical anterior: relato de caso

“…A hiperostose crônica parece ser relativamente bem tolerada até que um "evento gatilho", como asfixia, aspiração ou trauma cervical menor, promova um desbalanço na reserva compensatória já limítrofe, levando ao surgimento de um quadro clínico. Múltiplos mecanismos fisiopatológicos têm sido descritos para explicar a sintomatologia relacionada aos osteófitos, como (1) efeito de massa direto, causando obstrução mecânica ou desvio da faringe ou esôfago (2) ; ancoragem do esfíncter esofagiano superior (EES) ao nível da cartilagem cricoide (3) ; restrição ao movimento da laringe ou epiglote (4) ; inflamação do tecido mole subjacente, levando a fibrose e estenose; e (5) neuropatia inflamatória (9) .…”

“…Não existe uma correlação linear entre tamanho do osteófito e sintomatologia, mas se sabe que osteófitos maiores de 10mm aumentam significantemente o risco de aspiração (11) . Uma coorte recente com 10 pacientes portadores de OCA candidatos a tratamento cirúrgico mostrou que metade apresentava perda de peso e desnutrição devido à disfagia, ratificando que o quadro clínico pode ser grave (4) . Foi sugerido um critério de classificação para a intensidade da compressão da parede posterior da faringe.…”

“…Caso sejam mais volumosos, podem chegar a comprimir a parede posterior da faringe ou do esôfago, levando à disfagia orofaríngea. Em estados avançados, o idoso pode apresentar desnutrição e perda de peso devido à disfagia causada pelos osteófitos cervicais (4) .…”

A Curious Case of Dysphagia Due to Osteophytes

“…Although spinal osteophytes are common, occurring in one in every five elderly patients, less than 1% of osteophytes lead to dysphagia. [1][2][3][4][5] This case illustrates how a thorough investigation is essential to evaluate the cause of dysphagia. The patient is currently being managed through a conservative approach due to personal preference.…”