A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis
A 48-year-old male, who was being followed up for AS, visited our hospital complaining of progressive dysphagia. Difficulty swallowing solid foods started ~4 years prior, and for the last year, he suffered from dysphagia when swallowing both solid and liquid foods. The patient had no pain while swallowing, but did experience coughing, and had lost ~16 kg in the last 4 years.\nUpon physical examination, cervical motion was limited in all directions; the occiput-wall distance was 12 cm and chin-manubrium sterni distance was 7 cm. The patient had dorsal kyphosis with a Schober test score of 1 cm. A SI compression test was bilaterally positive; the Bath AS disease activity index was 4.7; and Bath AS functional index was 3.9. Laboratory tests showed that the whole blood count was within normal limits. Erythrocyte sedimentation rate was 25 mm/hour, and C-reactive protein was 19.8 mg/L (normal range, ≤ 5). Blood levels of urea, creatinine, transaminases, calcium, and alkaline phosphatase were all within normal limits. While he was negative for antinuclear antibody and rheumatoid factor, he was positive for HLA-B27.\nImaging studies revealed SI joint ankylosis and whiskering sign in pubic bones with simple pelvic radiography (). A bamboo spine appearance was present with simple thoracolumbar radiography (). Osteophytes were observed at the anterior corners of vertebra corpuses at C4-5 and C7-T1 levels with lateral cervical radiography (). Esophagography with barium revealed compression of the esophagus due to osteophytes. Cervical computed tomography, performed to localize the osteophytes and for differential diagnosis, revealed fusion between the C5-C6-C7 corpuses with prominent osteophyte formation anteriorly on the left at the C7-T1 level. This formation compressed the esophagus (). Cervical magnetic resonance imaging (MRI) was performed to rule out factors originating from soft tissues as causes of dysphagia. A large osteophyte formation on anterior vertebra corpuses at the C7-T1 level, which caused compression on esophagus, was defined in the cervical MRI ().\nThe patient was diagnosed with severe dysphagia because he could not swallow small solid foods and he complained of coughing when swallowing liquid and solid foods []. After consultation with an orthopedic surgeon, an operation for osteophyte excision was proposed, but the patient refused. Diet modification, antireflux and swallowing therapy were prescribed. However, after 6 months, dysphagia had not improved.