Causes resulting in an anterior cervical bony spur include: 1) ankylosing spondylitis; 2) diffuse idiopathic skeletal hyperosteosis (DISH) causing ossification of the anterior longitudinal ligament and tendon; and 3) degenerative intervertebral disc inflammation or intervertebral osteochondrosis.
6 The most common symptom caused by an anterior cervical bony spur is the worsening of dysphagia in consuming solid food. Approximately 28% of patients with the anterior cervical bony spur complain of dysphagia, 4% of which will visit a hospital with such a complaint.
6,
7 Dysphagia due to cervical osteophytosis is mainly developed from a mechanical obstruction of cricoid cartilage, secondary inflammation and edema. This results in pains and muscular spasm, as well as diseases, such as tumor in the hypopharynx, larynx, esophagus, vertebrae, lung, and mediastrinum, esophagitis, esophageal motor disease, esophageal stricture, pharyngoesophageal diverticulum, neuromuscular disease, cricopharyngeal rigidity, gastroesophageal reflux, stroke, and globus hystericus.
6 Therefore, it is important to perform a full medical history, neurological, and physical examination, as well as a blood test, endoscopic test, radiological test, and VFSS when patients complain of dysphagia. Treatment by cervical hyperostosis should be decided depending on pathogenesis of dysphagia, its severity, and conditions. A preferred treatment is to take anti-inflammatory agent or steroids to reduce edema or inflammation of the pharynx, bronchus, larynx, and esophagus regions.
3 Where there is no improvement even after drug medication and rehabilitation treatment and general weakness continues to progress from severe weight loss or continued aspiration pneumonia as shown in the patient of case 1, surgical treatment should be considered. This surgical treatment removes the mechanical compression of esophagus, and in most cases, there is an improvement of symptoms.
3 However, there are certain cases, such as the patient of case 3, where dysphagia reoccurs from reossification in long term follow-up even though the bony spur on the anterior cervical vertebra causing dysphagia had been removed. Miyamoto et al.
10 has identified that for all the patients who had their bony spur on the anterior cervical vertebra removed, reossification developed and growth rate of the bony spur was 1mm a year on average. The side effects of bony spur removal of the anterior cervical vertebrae include recurrent neuropalsy, hematoma, infection, and fistula formation.
5 There is therefore skepticism in the successful surgical treatment of old patients who often develops anterior cervical bony spur due to mortality and morbidity resulting from the surgery. The authors have observed a case where even though dysphagia symptoms were not severe, surgery to completely control the symptoms was difficult. In other cases, it was difficult to utilize conservative treatments to treat older patients with dysphagia due to anterior cervical osteophyte. In a third case, after removal of the anterior cervical bony spur and improvement of the dysphagia symptoms, the symptoms reoccurred from reossification and additional surgery was needed. Although surgical treatment is not the preferred approach for patients with dysphagia due to anterior cervical bony spur, it should be considered as one of the methods to improve the symptoms and resolve problems, such as aspiration pneumonia and weight loss resulting from the dysphagia. There is also a need to guide appropriate timing of surgical treatment for patients and a possibility of symptom reoccurrence from reossification after surgery with recommend long term follow-up.