Long-term results after surgical treatment of diffuse idiopathic skeletal hyperostosis (DISH) causing dysphagia

Scholz, Christoph; Naseri, Yashar; Hohenhaus, Marc; Hubbe, Ulrich; Klingler, Jan-Helge

doi:10.1016/j.jocn.2019.05.057

Cited by 31 publications

(33 citation statements)

References 25 publications

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“…Previous studies have described failure resulting from incomplete resection of osteophytes and osteophyte regrowth. 16,23 In this cohort, there were 5 patients (2 symptomatic and 3 asymptomatic) who showed osteophyte regrowth after osteophyte resection. However, previous studies have shown that it can take 10 or more years to become symptomatic from osteophyte regrowth.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 When conservative treatment fails, surgical osteophyte resection can improve hyoid movement, leading to enhanced upper esophageal sphincter opening 11 and symptoms of dysphagia. 3,6,7,11,[14][15][16][17][18][19][20][21][22][23][24] Given the relative rarity of symptomatic anterior cervical osteophytes being treated with surgical resection, the current literature consists of case reports and case series with relatively few patients. 3,6,7,9,11,[14][15][16][17][18][19][20][21][22][23][24][25] The purpose of this study was to review demographics, clinical characteristics, preoperative assessment, swallowing outcome, need for cervical fusion, delayed cervical instability, and osteophyte regrowth following primary resection of anterior cervical osteophytes as a treatment for dysphagia at our tertiary referral center.…”

Section: Introductionmentioning

confidence: 99%

“…Given the relative rarity of symptomatic anterior cervical osteophytes being treated with surgical resection, the current literature consists of case reports and case series with relatively few patients. 3,6,7,9,11,14 -25 The purpose of this study was to review demographics, clinical characteristics, preoperative assessment, swallowing outcome, need for cervical fusion, delayed cervical instability, and osteophyte regrowth following primary resection of anterior cervical osteophytes as a treatment for dysphagia at our tertiary referral center. We also report our current preferred surgical workup and operative technique using intraoperative navigation.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Kolz

Alvi

Bhatti

et al. 2020

Global Spine Journal

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Study Design: This was a retrospective cohort study. Objectives: When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. Methods: Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). Results: Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia ( P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. Conclusions: Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Kolz

Alvi

Bhatti

et al. 2020

Global Spine Journal

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“…12 Of these, only one of the patients developed worsening symptoms and required revision. 13 The other mechanism of recurrence and failure involves untreated pathology related to dysphagia. It has been hypothesized that hyperostosis may contribute to dysphagia via direct compression, local edema and inflammation, and spasm of adjacent of cricopharyngeal musculature.…”

Section: Discussionmentioning

confidence: 99%

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

Hines

Elmer

Detweiler

et al. 2020

Global Spine Journal

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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.

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Esophageal Disease in Older Patients

DeVault

Achem

2021

The Esophagus

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Long-term results after surgical treatment of diffuse idiopathic skeletal hyperostosis (DISH) causing dysphagia

Cited by 31 publications

References 25 publications

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

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

Esophageal Disease in Older Patients

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