1/28. Transpharyngeal approach for the treatment of dysphagia due to Forestier's disease.Forestier's disease (diffuse idiopathic skeletal hyperostosis) is characterized by extensive spinal osteophyte formation and endo-chondral ossification of paravertebral ligaments and muscles. Dysphagia in the setting of Forestier's disease is a rare and hence often unrecognized entity. The dysphagia is due to mechanical obstruction in the initial stages and later due to inflammation and fibrosis. Most of these patients are treated conservatively in the initial stages and later by excision of osteophytes through a lateral cervical approach. We present a case of dysphagia due to cervical osteophytes in the setting of Forestier's disease causing narrowing of the pharynx. The patient was treated surgically via a peroral-transpharyngeal route with excellent results.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/28. Dysphagia in a patient with giant osteophytes: case presentation and review of the literature.A patient with increasing dysphagia due to external bone compression of the oesophagus is presented. Radiographic evaluation revealed the underlying condition to be a diffuse idiopathic skeletal hyperostosis with exuberant and bumpy change within the anterior longitudinal ligament.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/28. Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans.BACKGROUND: Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. methods: A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS: In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS: While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
4/28. Cervical cord injury in an elderly man with a fused spine--a case report.We report a case of an elderly man presenting with co-existing diffuse idiopathic skeletal hyperostosis (DISH) and ossified posterior longitudinal ligament (OPLL) resulting in central cord syndrome. Only three such cases have been reported co-existing with DISH. The patient recovered most of his neurological deficit through conservative management. A discussion on the radiological features of DISH co-existing with OPLL and how these differ from ankylosing spondylitis (AS) follows.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/28. quadriplegia complicating ossification of the posterior longitudinal ligament.We report a case of quadriplegia complicating ossification of posterior longitudinal ligament (OPLL) in a patient who was also found to have diffuse idiopathic skeletal hyperostosis (DISH). She also had osteomalacia (Vit. D deficiency) with secondary hyperparathyroidism. There could be a cause and effect relationship between the abnormal biochemistry and OPLL.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
6/28. Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis.STUDY DESIGN: A rare case of retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis is presented. OBJECTIVE: To discuss the pathomechanism of retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: Reports describing craniovertebral manifestations of diffuse idiopathic skeletal hyperostosis are quite rare. Only two cases of an atlantoaxial subluxation and one case of an odontoid fracture have been reported. Myelopathy resulting from retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis has not been reported previously. methods: A 74-year-old man presented with spastic tetraparesis caused by a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. Transoral removal of the extradural mass combined with a dorsal atlantoaxial fusion was performed using a titanium frame with sublaminar cable wiring. RESULTS: Yellowish amorphous material extruded from between the odontoid process and the arch of C1 when the anterior capsule had been incised. The retro-odontoid mass was very firmly attached to the hypertrophied ligaments. The mass therefore had to be sharply dissected away to expose the dura. The histologic appearance of the mass consisted of poorly cell-degenerated ligament, fibrocartilage, and fibrin. There was a focal proliferation of small vessels, but no significant inflammatory component and no evidence of neoplasia. The ligaments appeared fibrillated, disintegrated, and fragmented. After surgery, the patient's neurologic function improved. CONCLUSIONS: This is the first reported case of a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. The secondary transfer of mechanical stress to the atlantoaxial segment was presented as a pathomechanism underlying the formation of this retro-odontoid pseudotumor.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
7/28. Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine.OBJECTIVES: To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). methods: Two patients, who presented with dysphagia resulting from large anterior osteophytes of the C-spine, were diagnosed as having DISH. A medline search from 1964 to present, using the terms "diffuse idiopathic skeletal hyperostosis" and "cervical spine," identified several clinical manifestations associated with DISH. RESULTS: Two groups of conditions associated with DISH were found. 1. Spontaneous complications such as: dysphagia, being the commonest, dyspnea, stridor, myelopathy associated with ossification of the posterior longitudinal ligament (OPLL) or with atlanto-axial pseudoarthrosis or subluxation. Other rare events were aspiration pneumonia, sleep apnea and thoracic outlet syndrome. 2. Provoked complications such as endoscopic and intubation difficulties and fractures of the C-spine with frequent transverse shift of the fractured segment and resultant myelopathy. CONCLUSIONS: C-spine involvement in DISH is a recognized cause of various clinical manifestations involving the pharynx, larynx and the esophagus. Prior knowledge of the existence of cervical DISH should alert the clinicians for possible complications, at times severe, during invasive procedures in the neck region and as a consequence of trauma.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
8/28. Diffuse idiopathic skeletal hyperostosis: an uncommon case of dysphagia in an older adult.Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among older adults. It is characterized by ossification of the anterior longitudinal ligament of the spine and various extra-spinal ligaments. Although stiffness and decreased range of motion of the spine are the most common clinical presentations of DISH, extra-skeletal manifestations may also be present. We report the case of a 65-year-old man complaining of progressive dysphagia due to DISH. barium swallow showed compression and lateral displacement of the cervical tract of the esophagus, secondary to compression by a large osteophyte. The patient received medical treatment with COX-2 inhibitors and liquid diet. In conclusion, DISH should be considered an important, although rare, cause of dysphagia among older adults. However, it should not be accepted as the cause of dysphagia until all other causes have been ruled out.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
9/28. Rapidly progressive dysphagia caused by Forestier's disease: a case report.Forestier's disease is a systemic rheumatologic abnormality of unknown etiology, characterized by a flowing ossification of the anterior ligament of the spine. In this case study we report on an atypical appearance of Forestier's disease in a 72-year-old woman. This patient had a one-month history of rapidly progressing dysphonia and dyspnea and at the time of admission was unable to eat. She had been operated for gastric and colon carcinoma seventeen months earlier. Total body CT scans showed a flowing ossification of the anterior ligament between levels C2 and C7 and an osteophyte protruding in the ventral direction at level C2. Before the osteophyte's removal, a tumor screening was conducted to exclude the presence of distant metastases or occult malignancy. Resection of the large osteophyte was performed via a typical ventral-cervical approach with horizontal skin incision. Six months after the procedure, the patient experienced distinct improvement of her condition and was able to eat both pulpy and solid foods again. In this case example, a rapidly progressive dysphagia was not caused by secondary malignancy, as initially speculated, but resulted from a ventral-cervical osteophyte, considered a rare cause for acute development of severe dysphagia. early diagnosis of Forestier's disease in this patient led to immediate surgical intervention, which proved to be adequate treatment and enabled the patient to make a good recovery.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
10/28. Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened. The postoperative evolution was uneventful.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
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