Anterior cervical spine surgery for treatment of secondary dysphagia associated with cervical myelopathy in patient with Forestier's disease

Abstract

Introduction

and importance: Forestier's disease, also known as a vertebral ankylosing hyperostosis or Diffuse Idiopathic Skeletal Hyperostosis (DISH), is a non-inflammatory enthesopathy that affects primarily elderly males and ossifies the anterolateral spine while sparing the intervertebral discs and joint spaces, especially at the cervical spine. Forestier's disease has resulted in the growth of large anterior cervical osteophytes that may compress the pharyngoesophageal region, producing dysphagia. However, symptomatic Forestier's disease presenting with dysphagia and cervical myelopathy is rarely observed.

Case presentation

A 48-year-old male presented with progressive dysphagia and cervical myelopathy. Based on the presence of radiographic study, Forestier's disease was suspected. Large anterior cervical osteophytes at C4–C6 levels compressed the pharyngoesophageal structure posteriorly. Multilevel degenerative discs compressing the C4 to C6 spinal cord were also seen on sagittal MRI T2-weighted images. Anterior cervical osteophytectomy with anterior cervical discectomy and fusion (ACDF) were performed. The patient made a complete neurological recovery and had no recurrent symptoms at the 5-year follow-up. The patient was extremely satisfied with this treatment and can improved his quality of life (QOL).

Clinical discussion

Treatment of symptomatic Forestier's disease with secondary dysphagia and cervical myelopathy is rare evidenced by the dearth of reports on surgical treatment. Surgical intervention appears to be safe, effective, and able to halt disease progression.

Conclusion

Anterior cervical osteophytectomy combined with ACDF with plate fixation is a preferred technique in both neural decompression and swallowing improvement. Surgical intervention, we consider, provides superior results than prolonged non-surgical treatments.

Highlights

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  Forestier's disease or Diffuse Idiopathic Skeletal Hyperostosis (DISH) presenting with secondary dysphagia associated with cervical myelopathy is a rare condition treated by surgery.

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  Anterior cervical osteophytectomy with simultaneous anterior cervical discectomy and fusion (ACDF) is a challenging surgical procedure for the patients in this condition.

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  Surgical management provides superior result than non-surgical treatments.