Cervical Alignment of Anterior Cervical Hyperostosis Causing Dysphagia

Area of Science:

• Orthopedics
• Gastroenterology
• Radiology

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by extensive ligamentous ossification, potentially leading to dysphagia.
• The precise mechanisms linking ossification to dysphagia severity in DISH remain unclear, despite esophageal compression being a suspected factor.

Purpose of the Study:

• To investigate the relationship between cervical alignment and dysphagia in patients diagnosed with DISH.
• To compare cervical spine parameters between patients with severe dysphagia requiring surgery and those with mild symptoms.

Main Methods:

• A retrospective case-control study comparing five patients who underwent anterior cervical hyperostosis resection (S group) with five patients managed conservatively (NS group).
• Patients were assessed using the Eating Assessment Tool-10 (EAT-10) for dysphagia severity and underwent plain kinetic radiography of the cervical spine.
• Key cervical spine angles (O-C2, M-C, C2-7, C2-6a) were measured in flexion, neutral, and extension positions.

Main Results:

• Preoperative EAT-10 scores were significantly higher in the S group (25) compared to the NS group (1), indicating severe dysphagia.
• Postoperative EAT-10 scores in the S group decreased to 1, signifying significant dysphagia improvement.
• Significant differences were observed in ΔC2-7 and ΔC2-6a between the S and NS groups, and between pre- and postoperative values within the S group.

Conclusions:

• Restricted cervical spine flexion due to ankylosis in DISH may contribute to the development of dysphagia.
• Surgical intervention can effectively alleviate dysphagia in patients with severe anterior cervical hyperostosis.