The association between cervical diffuse idiopathic skeletal hyperostosis and dysphagia

Area of Science:

• Radiology
• Orthopedics
• Gastroenterology

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH) is increasingly recognized as a cause of dysphagia due to anterior cervical osteophytes.
• Risk factors, severity determinants, and laterality patterns of cervical DISH in dysphagia patients are not well understood.

Purpose of the Study:

• To investigate associations between cervical DISH presence, severity, and laterality with clinical, metabolic, and nutritional factors in dysphagia patients.

Main Methods:

• Retrospective observational study of 208 dysphagia patients with head and neck CT scans (2014-2023).
• DISH diagnosed via Resnick criteria; severity classified by osteophyte thickness; laterality categorized (midline, right, left, bilateral).
• Clinical, metabolic, and nutritional variables compared using t-tests, Chi-square, and logistic regression; multivariate analyses identified predictors.

Main Results:

• DISH present in 38.9% of patients, who were older (75.2 vs. 68.3 years).
• Low serum albumin (<3.5 g/dL) associated with DISH presence (p=0.013) and severity (p=0.067).
• Independent predictors of DISH: low serum albumin (aOR=2.665) and drug use (aOR=2.015). Midline DISH (54.3%) linked to Parkinson's disease (p=0.005). Bilateral DISH showed 100% prevalence of low serum albumin (p=0.029).

Conclusions:

• DISH is an underrecognized dysphagia contributor, predicted by low serum albumin, COPD, and chronic pain.
• Severe DISH strongly correlates with low serum albumin, indicating nutritional compromise or systemic disease.
• Midline DISH is common, especially in Parkinson's disease; bilateral DISH suggests poor nutritional status, informing management and surgical decisions.