Dysphagia Caused by Anterior Cervical Osteophytes: Report of Three Cases

Anterior cervical osteophytosis – isolated and/or resulting from Forestier's disease – is commonly asymptomatic and can only occasionally produce dysphagia. In fact, although the cervical spondylosis and the dysphagia are common presenting problems, they are often unrelated each other. Review of literature showed that the association between the two conditions is relatively unfrequent and hence often unrecognized entity. The most likely mechanism of dysphagia is the interference with swallowing at the pharyngo-esophageal junction by mechanical obstruction of bony protuberance, although osteophytes in the lower cervical spine may also act on esophageal peristalsis inducing soft tissue inflammation. In first instance the diagnosis may be clearly suggested by conventional X-ray of the spine, avoiding potentially dangerous investigation (i.e. endoscopy); then it should be established by esophagogram, and CT. MRI of the spine should be additionally required if neurological impairement occurs. The therapeutic approach depends both on the extent of dysphagic complaints and on the presence of spinal cord involvement. There may be a role for medical therapy in the first instance under special circumstances (i.e. small osteophytes, transient dysphagia…). Surgical treatment is required after failure of conservative treatment and/or when bony spurs are located also on the posterior and postero-lateral aspects of vertebral body, thus extending into the spinal canal to impinge on the cord and roots. We report three cases of progressive spondylotic dysphagia with striking radiographic findings. The patients were treated conservatively in the initial stages. After unsuccessful medical therapy, surgical resection of the cervical osteophytes via the anterior cervical approach was performed and resulted in excellent relief of dysphagia in all cases.