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Bottom-to-top: A case report for treating esophageal cervical spondylosis with giant osteophytes
Lei Chen1, Shineng Lin, Zhenyu Shi
1Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang Province, China.
Rationale:
Esophageal cervical spondylosis is a rare condition characterized by dysphagia due to anterior cervical osteophyte compression. Existing surgical methods carry risks of esophageal injury and recurrence. This study introduces a novel "bottom-to-top" technique designed to safely resect large, adherent osteophytes while preserving esophageal integrity.
Patient Concerns:
A 67-year-old male presented with progressive dysphagia over one year, severely affecting food intake. His preoperative Eating Assessment Tool-10 score was 18, indicating significant swallowing impairment.
Diagnoses:
Imaging revealed significant anterior longitudinal ligament calcification and large osteophytes from C4 to C7, compressing the esophagus. The patient was diagnosed with esophageal cervical spondylosis after excluding gastrointestinal and other otorhinolaryngological disorders.
Interventions:
The patient underwent anterior C4/5 osteophyte resection, discectomy, and interbody fusion using the "bottom-to-top" approach, which involved resecting the osteophyte base first and progressing upward to minimize esophageal adhesion damage.
Outcomes:
Immediate postoperative improvement in dysphagia was observed. The Eating Assessment Tool-10 score decreased from 18 preoperatively to 0 at 1-year follow-up. Radiographs at 1 year showed satisfactory implant alignment without significant recurrence. At 3 years, mild neck stiffness and partial osteophyte regrowth were noted, but no recurrence of dysphagia occurred.
Lessons:
The "bottom-to-top" technique is effective for safely resecting large, adherent osteophytes in esophageal cervical spondylosis, reducing intraoperative esophageal injury and maintaining functional improvement. Long-term monitoring is essential due to the possibility of anatomical recurrence. This approach holds promise for similar challenging cases, though further studies are needed to optimize rehabilitation and prevent recurrence.
