Case Report
Forestier’s disease presenting with dysphagia and dysphonia

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Abstract

Forestier’s disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is a pathology of the vertebral bodies characterised by exuberant osteophyte formation. Symptoms range from negligible back discomfort to, less commonly, debilitating dysphagia and airway disturbances. Conservative management including analgesia, chiropractic and diet modification are common and effective treatments. However, when conservative management fails to alleviate symptoms, particularly compressive symptoms, surgical management is indicated. We report a 55-year-old man presenting with 6 months’ progressive dysphagia and dysphonia. He was managed successfully with an anterior cervical osteophytectomy without fusion. A literature review is included.

Section snippets

Case report

A 55-year-old man presented with a 6-month history of progressive dysphagia and dysphonia. This was associated with neck and shoulder discomfort – more neck stiffness than pain. He had a past medical history of an uncomplicated tonsillectomy and a carpel tunnel decompression. He was not on any medication and was allergic to penicillin.

On examination, he was neurologically intact with no clinical features of cervical spondylosis. A cervical X-ray and a subsequent CT scan demonstrated exuberant

Discussion

Forestier’s disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), was first described by Jacques Forestier and Jaume Rotes-Querol in 1950.1 It is a phenomenon characterized by the thickening and calcification of soft tissues namely ligaments, tendons or the joint capsules resulting in secondary formation of osteophytes.1, 2, 3 This disease most commonly affects the paraspinal ligaments – predominantly the anterior longitudinal ligament and occasionally the posterior

Conclusion

Although most patients with Forestier’s disease can be managed conservatively, for patients with symptoms justifying intervention, surgery is a safe and effective option. Patients do, however, require long-term follow-up.

References (18)

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    Conservative management options for ACH associated symptoms include diet modification and speech and swallow therapy. Anti-inflammatory, anti-reflux, antibiotic, steroid, muscle relaxant and sedative medications are also indicated [7,8]. Enteral feeding and gastrostomy may be required in refractory dysphagia.8

  • Diffuse Idiopathic Hyperostosis Manifesting as Dysphagia and Bilateral Cord Paralysis: A Case Report and Literature Review

    2018, World Neurosurgery
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    Tracheostomy and feeding tube placement should be reserved for patients who are poor surgical candidates or to improve nutritional and respiratory status before surgery.5 Improvement of symptoms could be in the immediate postoperative period7,23 or in the following 3 to 6 months.2,5,20 The treatement of patient with DISHphagia involves a team approach, including a spine surgeon, an otolaryngologist, and a speech therapist to rule out other causes of dysphagia (neuromuscular dysfunction, stroke, tumors, diverticula, and strictures).

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