Combined Anterior Osteophytectomy and Cricopharyngeal Myotomy for Treatment of DISH-Associated Dysphagia

Abstract

Study Design: Retrospective observational case series. Objective: To assess the outcome of patients with diffuse idiopathic skeletal hyperostosis (DISH) with dysphagia who underwent cricopharyngeal myotomy (CPM) in conjunction with anterior osteophytectomy (OP). Methods: This is a retrospective observational study of 9 patients that received combined intervention by neurosurgeons and otolaryngologists. Inclusion criteria for surgery consisted of patients who failed to respond to conservative treatments for dysphagia and had evidence of both upper esophageal dysfunction and osteophyte compression. We present the largest series in literature to date including patients undergoing combined OP and CPM. Results: A total of 88.9% (8/9) of the patients who underwent OP and CPM showed improvement in their symptoms. Of the aforementioned group, 22.2% of these patients had complete resolution of their symptoms, 11.1% did not improve, and only 2 patients showed recurrence of their symptoms. None of the patients in whom surgery was performed required reoperation or suffered serious complication related to the surgical procedures. Conclusion: Based on the literature results, high rate of improvements in dysphagia, and low rate of complications, combined OP and CPM procedures may be beneficial to a carefully selected group of patients.

Diffuse Idiopathic Skeletal Hyperostosis (DISH): Role of Logopedic Rehabilitation in Dysphagia

“…The mechanisms may be due to either post-surgical edema and consequent scarring or to spasms of the esophageal muscles following surgery. It is possible to overcome this muscular issue by performing a simultaneous cricopharyngeal myotomy [ 21 ]. However, surgical treatment is a valid alternative after the failure of the conservative management of a patient, especially when dysphagia worsens [ 22 ].…”

“DISH-phagia”: A Case Report and Review of Literature of a Rare Disease Manifestation

“…Von der Hoeh et al recommend osteophyte resection and intervertebral fusion with PEEK (polyetheretherketone) cages for augmented stability and to prevent osteophyte regrowth [14]. Shriver et al stated that instrumentation after osteophyte resection may lead to further compression of the esophagus and should not be recommended [15]. Hines et al hypothesized that upper esophageal sphincter dysfunction may contribute to dysphagia; therefore, cricopharyngeal myotomy may be considered as an additional procedure in the surgical treatment of DISH-related dysphagia [16].…”

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

“…While surgical treatment predominantly consisted of osteophytectomy alone in our sample, few case series have combined osteophytectomy with other surgical procedures. Some authors postulated that upper esophageal sphincter dysfunction may contribute to dysphagia, in which cricopharyngeal myotomy may be effective [126]. In a series of 9 patients undergoing osteophytectomy and cricopharyngeal myotomy, dysphagia resolved immediately and the complication rate was low, though dysphagia recurred in 2 patients during long term follow-up.…”