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Diagnosing Dysphagia in Forestier Syndrome: A Dynamic Digital Radiology Application.

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Summary

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier's disease, causes spinal calcification and can lead to dysphagia. Digital Dynamic Radiography (DDR) effectively visualized the cause of dysphagia in a patient with cervical DISH.

Keywords:
DDRForestier syndromedynamic imagingdysphagiaswallowing study

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Area of Science:

  • Radiology
  • Orthopedics
  • Gastroenterology

Background:

  • Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a non-inflammatory condition causing spinal ligament and entheses calcification.
  • It is characterized by flowing osteophytes, particularly along the anterior longitudinal ligament, with prevalence increasing with age and more common in males.
  • Cervical osteophytes in DISH can cause neck pain, stiffness, and compressive symptoms like dysphagia, impacting quality of life.

Purpose of the Study:

  • To report a case of Forestier's disease presenting with significant dysphagia.
  • To investigate the utility of Digital Dynamic Radiography (DDR) in evaluating dysphagia caused by cervical DISH.
  • To highlight the diagnostic and functional information provided by DDR in such cases.

Main Methods:

  • Conventional radiography for initial DISH diagnosis based on Resnick and Niwayama criteria.
  • Digital Dynamic Radiography (DDR) with barium administration to assess pharyngeal lumen narrowing.
  • Surgical resection of osteophytic and calcified components for symptom relief.

Main Results:

  • Cervical radiography confirmed DISH with coarse anterior osteophytes.
  • DDR revealed mechanical pharyngeal narrowing due to bulky anterior osteophytes, correlating with the patient's dysphagia.
  • Surgical intervention led to improved swallowing function, demonstrating the efficacy of addressing the osteophytic cause.

Conclusions:

  • DISH can lead to severe dysphagia due to cervical osteophyte formation.
  • Digital Dynamic Radiography (DDR) is a valuable tool for assessing the functional impact of cervical DISH on swallowing.
  • DDR provides crucial morphological and functional insights, aiding in the management of dysphagia associated with cervical DISH.