Diffuse Idiopathic Skeletal Hyperostosis (DISH) Causing Dysphagia
The patient is a 60-year-old male presenting with progressive dysphagia and sleep apnea for which he uses a C-PAP. He has no neck pain but notes a limitation of his range of motion.
On examination, he has a normal neurologic exam. He has decreased cervical range of motion.
No prior treatment.
Radiographs in Figures 1 and 2 (above) show diffuse idiopathic skeletal hyperostosis (DISH); anterior osteophytes appear to be flowing, disc height is preserved.
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His dysphagia improved immediately post-operatively. At one year, he is still improved, and has no dysphagia.
Often, spine surgeons are called upon by our colleagues to surgically treat aggressive anterior osteophytosis to aid in addressing swallowing dysfunction. Questions to be asked are:
1. Do we believe the osteophytes are truly causing the swallowing dysfunction, and can it be proven with any other type of evaluation?
2. What is the best surgical approach?
3. Should we just remove the osteophytes?
4. Should we do a fusion at the level of maximum impingement, or the levels that we removed the osteophytes from?
5. What is the best methodology to prevent recurrence?
I would not have predicted that the patient presented would have as severe swallowing dysfunction from the degree of osteophytosis seen in the studies. If I were to embark on a surgical intervention, I would have a thorough discussion with the patient, ensuring that he understood the intervention may not be successful, and further work-up, and treatment may be necessary by the referring physician.