Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
4 (
3
); 336-337

Commentary

From Service of Neurology, University Hospital “Marqués de Valdecilla” (IFIMAV), University of Cantabria, and “Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas” (CIBERNED), Santander, Spain

Address for correspondence: Dr. Javier Riancho, Service of Neurology, University Hospital “Marqués de Valdecilla”, Av Valdecilla s/n, 39008 Santander, Spain. E-mail: jariancho@humv.es

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

In this issue of the Journal, Dable et al. reported a patient suffering from dysphagia secondary to cervical osteophytes whose diagnosis was initially masked by presence of tooth-related pathology.[1]

The word dysphagia derives from the Greek words “dys” (with difficulty) and “phagia” (to eat). Dysphagia has been classically divided into organic and neurogenic, depending on whether the difficulty is on swallowing solids or liquids, respectively.[2]

Dysphagia for solids is usually secondary to structural disorders such as tumours, peptic stenosis, or esophageal rings, while on the other hand, neurological disorders as vagus or glossopharyngeal nerve palsies, lacunar syndromes, and dementia and other degenerative disorders are commonly associated with impairment of liquids intake.[3]

Pain is the most frequent manifestation in cervical osteoarthritis. However, sometimes it can present with coughing, aspiration, or dysphagia due to pharynx or esophagus compression by osteophytes. Although osteophyte-related dysphagia is rare, it can occasionally be severe and cause marked loss of weight.[4] As has been previously discussed, the proposed mechanisms include the direct extrinsic compression, and the presence of edema and muscle spam secondary to esophageal irritation.

Idiopathic diffuse skeletal hyperostosis (IDSH) is another skeletal disease associated with osteophytes, which may be particularly large. Resnik et al. published one of the largest case series of IDSH. He reported 21 patients with IDSH. Dysphagia was the first symptom in only one patient, but more than 25% presented some degree of swallowing difficulty during the course of disease.[5] Other conditions associated with osteophytosis include traumatisms and spine surgery.[6]

Treatment of patients with dysphagia related to cervical osteophytes should be individualized. In mild cases with minor symptoms conservative therapy consisting on soft diet, non-esteroidal anti-inflammatory drugs, or even, short-term steroids at low dose may be tried.[7] On the other hand, when patients have severe manifestations accompanied by weight loss, a surgical correction may be indicated. There are no large series in the literature. However, surgical treatment seems to be generally successful and have a low complication rate.[8] A course of medical therapy may be tried before surgery.

Although dysphagia associated with cervical osteophytosis is a rare entity, clinicians should consider it when attending patients in risk (occupational predisposition, history of previous traumatism) and when the exam shows pharingoesophageal stenosis with a normal mucosa. In those cases, a simple procedure such as a lateral neck X-ray may be diagnostic. A CT scan and a barium esophagram may help to delineate the lesions.

References

  1. , , , , . A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain. J Neurosci Rural Pract. 2013;4:334-36.
    [Google Scholar]
  2. , , . Evaluation of dysphagia: A careful history is crucial. Dysphagia. 1987;2:65-71.
    [Google Scholar]
  3. , , , , . Functional lesions in dysphagia due to acute stroke: Discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography. Neuroradiology. 2013;55:413-21.
    [Google Scholar]
  4. , , , , . Cervical osteophytes: A rare cause of weight loss. Rev Clin Esp. 2012;212:e33-5.
    [Google Scholar]
  5. , , , , , , . Diffuse idiopathic skeletal hyperostosis (DISH) [ankylosing hyperostosis of Forestier and Rotes-Querol] Semin Arthritis Rheum. 1978;7:153-87.
    [Google Scholar]
  6. , , , , , , . Dysphagia and soft-tissue swelling after anterior cervical surgery: A radiographic analysis. Spine J. 2012;12:639-44.
    [Google Scholar]
  7. , , , , . Osteophyte-induced dysphagia: Report of three cases. Joint Bone Spine. 2002;69:226-9.
    [Google Scholar]
  8. , , , , , . Anterior cervical osteophyte dysphagia: Manofluorographic and functional outcomes after surgery. Head Neck. 2010;32:588-93.
    [Google Scholar]

    Fulltext Views
    967

    PDF downloads
    286
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections