Ann Rehabil Med.  2012 Oct;36(5):729-734.

Surgical Treatments on Patients with Anterior Cervical Hyperostosis-Derived Dysphagia

• Song AR
• Yang HS
• Byun E
• Kim Y
• Park KH
• Kim KL

Abstract

Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight loss, another complained of dysphagia only when swallowing pills, and the third experienced recurrence symptom with reossification. All patients reported gradual improvement of dysphagia immediately after their cervical osteophytes were resected through the anterior approach. In relation to postoperative improvement, however, they expressed different degrees of satisfaction according to severity of symptoms. Surgical treatment, performed for the anterior cervical hyperostosis-derived dysphagia, can immediately relieve symptoms of difficulty in swallowing. This might especially be considered as an appropriate treatment option for severe dysphagia.

Keyword

Dysphagia; Hyperostosis; Surgical procedure

MeSH Terms

Deglutition
Deglutition Disorders
Humans
Hyperostosis
Osteophyte
Pneumonia, Aspiration
Recurrence
Weight Loss

Figure

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  Fig. 1 Three-dimensional reconstruction computed tomography of cervical spine: anterior cervical osteophytes are revealed from C2 to C7 levels with the C4 level being the most prominent (A). Post-anterior approach of the cervical spine osteophytes resection at C2 to C7 levels (B).

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  Fig. 2 The first video fluroscopic swallowing study (VFSS) showed a nasal regurgitation of contrast (A). After completing ten sessions of neuromuscular electrical stimulation (VitalStim®), the nasal regurgitation vanished. However, VFSS still showed minimal amount of retention of contrast in the valleculae and pyriform sinuses (B). 7 months later, the patient was suffering from an exacerbated symptom of difficulty in swallowing. A 10 cc water swallowing test showed moderate amount of retention of contrast in the valleculae and pyriform sinuses (C). After removing the anterior cervical osteophytes, retention of contrast in the valleculae and pyriform sinuses was not evident at follow-up VFSS (D).

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  Fig. 3 Three-dimensional reconstruction computed tomography of the cervical spine revealed anterior cervical osteophytes from C4 to C6 levels (A). Post-anterior approach of the cervical spine osteophytes resection at C4-5-6 levels (B). Pre-operative video fluroscopic swallowing study (VFSS) showed the presence of laryngeal penetration in 10 cc water swallowing test (C). After removing the anterior cervical osteophytes, laryngeal penetration was not detected at follow-up VFSS (D).

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  Fig. 4 The lateral view of cervical X-ray revealed anterior cervical osteophytes at C2 and C3 levels (A). Post-anterior approach of the cervical spine osteophytes resection at C2-3-4-5 levels (B). Pre-operative video fluroscopic swallowing study (VFSS) showed the presence of laryngeal penetration in a 5 cc water swallowing test (C). After removing the anterior cervical osteophytes, laryngeal penetration and retention of contrast in pyriform sinuses were not detected at follow-up VFSS (D).

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