Progressive dysphagia and neck pain due to diffuse idiopathic skeletal hyperostosis of the cervical spine: a case report and literature review
The study has been approved by the Committee for Human Research at Navy General Hospital, and written informed consent was collected from the patient.\nA 71-year-old Asian man was referred to the orthopedic clinic of Navy General Hospital with the main complaint of chronic neck pain for 5 years and increased difficulty in swallowing solid food over the past 3 years. The neck pain was dull and progressive but generally tolerated by the patient. Sometimes neck pain would become sharp with certain body movements such as twisting or bending over. Over the past year he had altered his diet to include only soft foods and liquids, and he had an approximately 5 kg weight loss over that period of time.\nEsophagogastroduodenoscopy had been done 2 years before, and the results were unremarkable. He denied difficulty in breathing and any symptoms suggestive of cervical radiculopathy or myelopathy. The patient had had type 2 diabetes for 12 years and had been admitted to the local hospital on two previous occasions for control of his disease.\nOn physical examination, the patient was alert, afebrile, and well oriented, with stable vital signs. Cervical range of motion was significantly decreased, and a hard lump could be felt deep in the anterolateral cervical region. The neurological exam and the patient’s reflexes were normal. The patient did not show clinical, radiological, or serological evidence of rheumatoid arthritis or of ankylosing spondylitis. His neck disability index score was 62% and the visual analogue scale score for neck pain was 7 while hospitalized in our clinic.\nLaboratory tests including blood cell count, C-reactive protein, erythrocyte sedimentation rate, and autoimmune panel were normal. The lateral radiograph of his cervical spine showed characteristic flowing ossification along the anterior aspect of the cervical vertebrae from C2–C5, with relative preservation of the disc spaces (). The facet joints and spinous processes did not appear ankylosed. The bony mass compressed the esophagus anteriorly and resulted in marked swallowing tube stenosis. The computed tomography scan of the cervical spine revealed continuous but irregular flowing hyperostosis alongside the anterior aspect of all the cervical vertebrae as well as local ossification of the posterior longitudinal ligament (). There were especially striking osteophyte outgrowths covering the anterior side of the vertebrae and projecting into the soft tissues of the neck from the level of C2 to C5 (). The largest bony excrescences measured 16.32 mm thick. The anterior edge of the body of the vertebrae was clearly visible at the posterior limit of the outgrowth except at C4. Sagittal T2-weighted magnetic resonance imaging showed bone marrow signal abnormality (high signal intensity) in C5–C7 as well as in the outgrowth hyperostosis (). Magnetic resonance imaging did not show obvious spinal stenosis and cord compression. The features were characteristic of DISH or Forestier’s disease.