Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is rarely symptomatic. However, it can present with dyspnea, hoarseness, dysphagia, and stridor. An 80-year-old chronic smoker male presented with 6-month history of sore throat and progressive dysphagia. Computed tomography of the neck revealed bulky anterior bridging syndesmophytes along the anterior aspect of the cervical spine and facet effusion involving four contiguous vertebrae consistent with DISH. Dysphagia secondary to DISH was diagnosed. Fiberoptic laryngoscopy showed bilateral vocal cord paralysis. Patient's airway became compromised requiring tracheostomy tube placement. After discussion of therapeutic options, patient agreed on a percutaneous endoscopic gastrostomy tube insertion for nutritional support. Osteophytectomy was left to be discussed further.

Multi-Level forestier syndrome in the cervical vertebra with an unusual radiographic appearance: Case report

“…Forestier disease is defi ned as a non-infl ammatory ossifi cation of spinal and peripheral elements [5,6] and was fi rst reported by Forestier and Rotes-Querol in 1950 [5] and later named as DISH by Resnick, et al, in 1975 [7]. Three criteria for diagnosis is crucial for this condition: ossifi cation of the anterior longitudinal ligament in at least four vertebral bodies successively, preservation of intervertebral disc height and intra-articular osseous fusion or sclerosis with absence of apophyseal joint bone ankylosis and sacroiliac joint erosion [5,8]. It is mostly seen in the thoracic region [5,9], but cases of the other vertebra segments are reported as well.…”

“…Incidences vary between 2.9-28% in general [3]. Obesity, diabetes mellitus, hypertension, acromegaly, hypervitaminosis A are some risk factors for Forestier disease [8,11]. Most of the patients are asymptomatic are only diagnosed incidentally on radiographic fi ndings but may vary depending on the size and localization of the ossifi cations [9].…”

“…Most of the patients are asymptomatic are only diagnosed incidentally on radiographic fi ndings but may vary depending on the size and localization of the ossifi cations [9]. Dysphagia, being the most prominent symptom is seen in 17-28% of patients with cervical DISH due to compression of the esophagus by the osteophytes [5,8,9].…”

“…Treatment may be either conservative or surgical however conservative treatment is adequate for most of the patients [5]. For patients with dysphagia, airway compromise and rapid weight loss, surgery should be the initial choice of treatment [8]. For the surgical treatment, anterior approach with special caution to the adhesions between the osteophytes and pharyngo-esophageal segment, may be preferred [9].…”

Oropharyngeal dysphagia as an uncommon manifestation of an osteoarticular disease

“…It is a rare non-inflammatory disorder characterised by calcification and ossification of spinal ligaments and enthuses, and osteophyte formation 5. Its prevalence increases with age, being more frequent after the fifth or sixth decade of life, and is more common in men than in women 6 7…”