Dysphagia induced by a cervical osteophyte: a case report of cervical spondylosis

摘要

Mechanical oesophageal dysphagia is caused by either an extrinsic compression of oesophageal lumen or intrinsic pathologies of oesophageal wall. The oesophagus may be compressed externally by an enlarged thyroid gland, vascular pathologies, a mediastinal mass, or a retropharyngeal abscess. In addition, skeletal pathologies such as anterior osteophytic bridges due to diffuse idiopathic skeletal hyperostosis ( DISH ), degenerative osteophytes, congenital bone bars, atlantoaxial dislocation, anterior herniation of calcified nucleus pulposus, rheumatoid pannus of the cervical spine, and ankylosing spondylitis causing anterior longitudinal ligament calcification can all produce external compression of the oesophagus and consequent dysphagia. The main clinical symptom of cervical spondylosis is pain partly caused by nerve root compression due to degeneration of the structural elements of the cervical spine. However, osteophytic compression on other neighbouring tissues can cause some rare symptoms, one of which is dysphagia induced by anterior vertebral osteophytes. The first report defining cervical oesophageal compression was by Mosher, who described two patients complaining of dysphagia due to cervical osteophytes in 1926. Anterior cervical osteophytes occur in 20% -30% of the elderly population, and generally remain asymptomatic. Twenty-eight percent of patients with anterior cervical osteophytes complain of dysphagia, whereas 17% of patients with DISH are similarly symptomatic. Cervical spondylotic dysphagia is a rarer symptom, generally overlooked, and often misdiagnosed and treated inappropriately. In this paper, we describe a patient with cervical spondylosis who complained of difficulty in swallowing food due to a cervical osteophyte, and who had been treated improperly. We also discuss diagnostic and therapeutic approaches to this rare condition.