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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forestier disease, or ankylosing hyperostosis, is a common disorder of middle-aged and elderly persons. Characteristic clinical and radiographic features enable the physician to distinguish between this disease and ankylosing spondylitis. The principal clinical features include aching spinal stiffness with relative preservation of function and minimal evidence of spinal immobility. Many patients have elbow and heel pain and dysphagia. Typical radiographic findings are ligament ossification, para-articular osteophytosis, and bone production at sites of tendon and ligment attachment in spinal and extraspinal locations. The extraspinal roentgenographic manifestations are so characteristic that when present, they allow the diagnosis of spinal ankylosing hyperostosis to be suggested, even in the absence of axial radiographs.
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PMID:Diffuse skeletal abnormalities in Forestier disease. 93 66

Radiographic, clinical and pathologic abnormalities of diffuse idiopathic skeletal hyperostosis (DISH) are presented. Definite criteria must be fulfilled to differentiate DISH from other diseases of the spine, especially intervertebral osteochondrosis and ankylosing spondylitis. A case of massive DISH in the cervical spine causing dysphagia is described.
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PMID:[Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia]. 357

Esophageal involvement in scleroderma is generally confined to the body, manifested manometrically as impaired motility and decreased lower esophageal sphincter tone. Pharyngeal dysfunction has not been recognized. This is a report of a patient with the rare combination of scleroderma and ankylosing spondylitis, whose presenting complaint was transfer dysphagia due to impaired relaxation of the upper esophageal spincter as a result of tight overlying cervical skin, or sclerodermatous involvement of the sphincter itself.
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PMID:Transfer dysphagia in a patient with the rare combination of scleroderma and ankylosing spondylitis. 366 94

Esophageal perforation in ankylosing spondylitis (AS) is a rare complication in anterior cervical spine surgery and has not been reported before. A 50-year-old patient with AS developed incomplete tetraplegia after minimal trauma. C5 pedicle fracture was diagnosed and treated predominantly by physical therapy until neurological symptoms progressed. Cervical spine MRI showed C6/7 fracture and spinal cord compression. The patient underwent dorsal laminectomy, C5-7 anterior cervical fusion using allograft iliac crest and CASPAR-plate fixation. Delayed esophageal perforation appeared 10 months postoperatively when he came first to our hospital. He complained of dysphagia and developed acute dyspnea. Posterior stabilization with two plates was performed followed by removal of the ventral plate and screws. The esophageal laceration was sutured. The patient was treated with antibiotics and percutaneous endoscopic gastrostomy. Position of fracture and implants were accurate at 18 months postoperatively. The patient had persistent minor neurological deficits (Frankel D) at last follow-up. We conclude that esophageal perforation after anterior spinal fusion is a rare complication. Minor traumas in patients with AS are unstable and can result in significant spinal injury. Dorsoventral stabilization should be performed to avoid further complications.
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PMID:Late esophageal perforation complicating anterior cervical plate fixation in ankylosing spondylitis: a case report and review of the literature. 1507 48

Forestier's disease now called DISH (diffuse idiopathic skeletal hyperostosis) is a non inflammatory enthesopathy ossifying the anterolateral spine and sparing the disc and joint space in elderly men, mostly at thoracic levels. Radiology performed for minor trauma or to explore a stiff neck provides the diagnosis. The main differential diagnosis is ankylosing spondylitis presenting an inflammatory profile as well as previously existing alterations of the sacroiliac joint. Retinoic acid treatment or ossification of the posterior longitudinal ligament should also be discussed. Dysphagia is the most frequent symptom, but neurological signs are rarely observed. We report a case observed at the cervical level. Anterior decompression and cage-fusion was indicated. Ongoing hyperostosis was also documented. Surgery in DISH is mainly indicated for dysphagia and rarely after cervical trauma. Of note are associated lesions such as OPLL (ossification of the posterior longitudinal ligament) or synovial cysts responsible for the exceptional and severe myelopathy presentation. The neurosurgical community should become better aware of Forestier's disease.
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PMID:[Surgical management of cervical radiculopathy in Forestier's disease. Case report and review]. 1585 61

Long-standing ankylosing spondylitis may predispose a patient to serious cervical injury in the setting of minor trauma. Early diagnosis is essential to a favorable outcome. We report a 75-year-old man whose relatively minor trauma in the setting of AS resulted in a cervical fracture and callus formation, which masqueraded as a tumor. The patient developed neck pain, bilateral hypoglossal nerve palsy with dysarthria, and dysphagia that ultimately resulted in his death. This case illustrates progressive neurologic signs of gradual disarticulation of the skull from the cervical spine. The situation is considered of importance because it emphasizes the need for early recognition and possible intervention in the presence of hypoglossal symptoms. The specific combination of long-standing ankylosing spondylitis and minor trauma is one setting in which a clinician must be alerted. Early consideration of neck immobilization is emphasized.
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PMID:Minor neck trauma in chronic ankylosing spondylitis: a potentially fatal combination. 1741 35

Ankylosing spondylitis can lead to severe cervical kyphosis, causing problems with forward vision, swallowing, hygiene, patient functionality, and social outlook. Evaluation of patients with cervical flexion deformity includes assessment of global sagittal balance and chin-brow angle. The primary treatment in extreme disabling cases is surgical correction involving a posterior cervical extension osteotomy, which is a technically demanding procedure with considerable risk of neurological injury. To address the potential complications with extension osteotomy, the authors of several reports have described modifications to the surgical technique. These developments incorporate recent advances in anesthesia, neuromonitoring, and spinal instrumentation. Complications associated with the procedure include subluxation at the osteotomy level, spinal cord injury, radiculopathy, dysphagia, and pseudarthrosis. Although the risks of spinal correction are considerable, extension osteotomy remains an effective treatment modality for patients with disabling cervical flexion deformity.
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PMID:Management of cervical deformity in ankylosing spondylitis. 1829 Jul 47

Spinal deformities can result in increasing thoracic kyphosis or loss of lumbar lordosis, leading to imbalance in the sagittal plane. Such deformities can be functionally and psychologically debilitating. The Smith-Petersen osteotomy can achieve approximately 10 degrees of correction in the sagittal plane at each spinal level at which it is performed. This osteotomy is beneficial for patients who have a degenerative imbalance in the sagittal plane. The pedicle subtraction osteotomy can achieve approximately 30 degrees to 40 degrees of correction in the sagittal plane at each spinal level at which it is performed. It is the preferred osteotomy for patients with ankylosing spondylitis who have an imbalance of the spine in the sagittal plane. The cervical extension osteotomy is performed in the cervical spine, at the cervicothoracic junction, in patients who have a cervical flexion deformity that impedes their ability to look straight ahead while walking or who have difficulty swallowing. The vertebral column resection is used when the imbalance is severe enough that the other osteotomies cannot correct the deformity, especially in patients who have a combined sagittal and coronal spinal imbalance. Neurologic problems, whether transient or permanent, are the most commonly encountered complications following these procedures. Recent results have shown a high patient satisfaction rate and good functional outcomes after spinal osteotomies done to treat a variety of disorders.
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PMID:Corrective osteotomies in spine surgery. 1897 21

Anterior Cervical Hypertrophic Osteophytosis (ACHO) is a clinical entity caused by degenerative changes of the cervical spine. ACHO may also be found in Diffuse Idiopathic Skeletal Hyperostosis (DISH)1-3, Ankylosing Spondylitis and Post-traumatic Osteophytogenesis. In a minority of cases it may lead to oesophagical manifestations and less commonly, to respiratory complaints. The authors report the case of a 75-year-old male with a personal history of chronic tophaceous gout and chronic obstructive lung disease. The patient presented with a history of progressive worsening of dyspnoea and dysphagia (for solid food) as well as foreign body sensation at the cervical level. On general examination, the patient presented with slightly diminished breath sounds and an increased expiratory time. On rheumatologic examination, the patient had moderate limitation of all cervical movements, crepitating knees and multiple gout tophi in both hands. Cervical plain radiographs showed large anterior osteophytes at the level of C4 and C5. Flexible videobronchoscopy was also performed, showing an angle of distortion in the upper third of the tracheal wall, caused by extrinsic compression. These changes were confirmed by cervical CT scan which also documented an anterior sliding of the oesophagus due to large anterior cervical osteophytes. Videofluoroscopic swallow study revealed the presence of paradoxal contraction of the cricopharyngeal muscle. The patient was treated with a non-steroidal anti-inflammatory drug (NSAID) and a skeletal muscle relaxant. Dysphagia improved but not the respiratory symptoms. Although there was indication for surgical removal of the hypertrophic osteophytes, the patient refused surgery and continues to be followed-up regularly at our outpatient clinic.
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PMID:[Tracheal stenosis by extrinsic compression: a case of anterior cervical hypertrophic osteophytosis]. 2097 45

Cervical bony outgrowths or osteophytes are common and usually asymptomatic. In some cases, they may be associated with dysphagia, dysphonia, dyspnea and pulmonary aspiration. The most common causes of cervical osteophytes are osteoarthritis, ankylosing spondylitis and ankylosing hyperostosis or Diffuse Idiopathic Spinal Hyperostosis (DISH), also known as Forestier's Disease. Other causes are hypoparathyroidism, trauma, acromegaly, ochronosis and flourosis. However, while dysphagia due to osteophytes is reported in the setting of DISH, it is very rare with osteoarthritis. We report a case of a patient who developed dysphagia due to anterior cervical osteophytes in the setting of osteoarthritis.
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PMID:Dysphagia due to cervical osteophytes. 2267 83


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