Giant Anterior Cervical Osteophyte Leading to Dysphagia
A 56-year-old man presented with increasing dysphagia, dysphonia, moderate neck pain and neck stiffness. The patient had no history of trauma to the neck. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Neck motion was decreased. And neurologic examination was normal. Routine blood tests were also normal. Plain radiographs of the cervical spine showed extensive ossification at the anterior longitudinal ligament along the left anterolateral aspect of the vertebral bodies from C2 to T1, especially prominent at C4-5, suggesting DISH. Linear breakage of the ossification is noted at C4-5 (). In radiographs of the thoracic and lumbar spine, multiple bony spurs were identified, too. There was no definite radiographic instability on the cervical dynamic view. Cervical computed tomography (CT) confirmed the giant anterior osteophyte (). Barium contrast swallow cinematography revealed a filling defect along the pharynx with lateral displacement of the esophagus due to giant anterior osteophyte ().\nThe patient underwent surgery with a left-sided anterolateral cervical approach to the spine. The prevertebral fascia was separated and the trachea and esophagus were retracted on the right side, with the carotid sheath on the left side. The C4-5 level was exposed. The giant anterior osteophyte was removed with rongeurs and a high speed drill until the anterior spinal surface from C3 to C6 was flat. All cervical segments except C4-5 were fused due to DISH. We perceived the C4-5 segment to be unstable. So we removed the disc of C4-5 and performed C4-5 interbody fusion using an allograft mixed demineralized bone matrix (DBM) and anterior cervical plate. After several days, we performed posterior screw fixations from the C3 level to the C6 level. A postoperative lateral plain cervical spine radiograph demonstrated removal of the anterior cervical osteophyte at C4-5 ().\nAfter the surgery, the patient was mobilized with a collar. Immediately following surgery, dysphagia was improved. The postoperative barium contrast swallow cinematography demonstrated improvement of the filling defect along the pharynx due to removal of the ossified anterior longitudinal ligament (). The patient was discharged without any complications through postoperative ten days. One year later, cervical CT showed bony fusion at C4-5 bodies and no recurrence of anterior cervical osteophyte (). The patient did not complain about the dysphagia.