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Severe Aerodigestive Compromise Caused by Cervical Diffuse Idiopathic Skeletal Hyperostosis: A Case Report
B M Santhan Kumar Reddy1, K Gavi Krishna1, M Mahesh1
1Department of Orthopaedic Surgery, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
Introduction:
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory enthesopathic disorder characterized by flowing ossification along the spine. Cervical involvement may compress the aerodigestive tract, causing dysphagia, aspiration risk, and malnutrition.
Case Report:
An 82-year-old male presented with 9 months of progressive dysphagia and odynophagia, eventually intolerant even of liquids, with ~10 kg weight loss. Radiographs demonstrated flowing anterior ossification from C2 to C7; barium swallow confirmed bolus hold-up at C5-C6; computed tomography (CT) revealed bulky ventral osteophytes; magnetic resonance imaging (MRI) excluded myelopathy. Following failed conservative management, anterior cervical osteophytectomy (C3-C7) was performed. Objective outcomes measured pre-operative, at 1 month post-operative, and at 2-year follow-up improved from Functional Oral Intake Scale 2 → 6 → 7, Eating Assessment Tool-10 32 → 8 → 2, M.D. Anderson Dysphagia Inventory global 48 → 86, and Prevertebral Soft Tissue 2.6 mm → 5.1 mm → 3.9 mm, with full dietary normalization and no recurrence at 2-year follow-up.
Discussion:
The diagnostic pathway (radiographs → barium swallow → CT ± MRI) aligns with commonly recommended approaches for evaluating mechanical dysphagia. Surgical osteophytectomy is highly effective, with ~95% improvement and ~4% symptomatic recurrence reported in systematic reviews.
Conclusion:
Timely recognition and osteophytectomy for severe cervical DISH can restore complete functional swallowing, objectively verified across validated outcome measures, with durable remission at 2 years.
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