Hyperextension-distraction fractures in ankylosing and spondylotic spines: injury profile and treatment results.

STUDY DESIGN: Case series study. PURPOSE: To describe demographic metrics, and clinical and radiographical outcomes of surgical treatment in patients with ankylosed spine (ASP) such as diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis (AS) and non-ankylosed spines (NAS) suffering from hyperextension-distraction spine fractures. METHODS: Patients diagnosed with hyperextension-distraction fractures between 2012 and 2020 were identified. A retrospective analysis of clinical and surgical data was performed. Similarities between patients with ASP and NAS were evaluated by Fisher's exact test. RESULTS: Of the 22 patients, 13 had ASP (10 patients with DISH, 3 AS) and nine NAS. Most of these injuries involved the thoracolumbar spine (45.4%). All patients with NAS presented some sign of spondylosis: facet joint degeneration, intervertebral osteochondrosis, and anterolateral osteophytes. None of the patients with NAS and 30.7% with ASP suffered low-energy mechanisms (p = .11). All the patients with NAS and 61% of the patients with ASP had associated injuries (p = .04). On average, the instrumented levels were four (range, 2-6), achieving a fusion rate of 94.7% in all groups. Most of the ASP and NAS presented post-operative complications respectively (p = .65). CONCLUSION: Hyperextension-distraction spine fractures are not unique in ASP. In patients with spondylosis and high-energy accidents, we should suspect those fractures and rule out associated injuries, fractures in other vertebral segments, and acute spinal cord injury. The four-level instrumentation achieved an effective fusion rate in all patients.

Diffuse idiopathic skeletal hyperostosis causing dysphagia in a young patient.

Diffuse idiopathic skeletal hyperostosis (DISH) is an under-diagnosed condition producing flowing ossification of the antero-lateral ligaments of the spine. Affecting predominantly males over 65 years old, it is an unusual cause of dysphagia and dysphonia. We report a 45-year-old mole with a three years history of dysphonia and three months of dysphagia. The initial diagnosis was gastroesophageal reflux, and an endoscopy ruled out esophageal luminal pathology. Cervical spine radiographs showed ossification of the cervical anterior longitudinal ligament with large, prominent osteophytes from C3 to C6, producing esophageal and upper airway compression; these images were compatible with DISH. Cervical osteophyte resection resulted in complete resolution of symptoms. DISH should be considered in the differential diagnosis of dysphagia and dysphonia.

Disfagia cervical espondilótica por hiperostosis esquelética difusa idiopática en un paciente joven / Diffuse idiopathic skeletal hyperostosis causing dysphagia in a young patient

Diffuse idiopathic skeletal hyperostosis (DISH) is an under-diagnosed condition producing flowing ossification of the antero-lateral ligaments of the spine. Affecting predominantly males over 65years old, it is an unusual cause of dysphagia and dysphonia. We report a 45-year-old mole with a three years history of dysphonia and three months of dysphagia. The initial diagnosis was gastroesophageal reflux, and an endoscopy ruled out esophageal luminal pathology. Cervical spine radiographs showed ossification of the cervical anterior longitudinal ligament with large, prominent osteophytes from C3 to C6, producing esophageal and upper airway compression; these images were compatible with DISH. Cervical osteophyte resection resulted in complete resolution of symptoms. DISH should be considered in the differential diagnosis of dysphagia and dysphonia.

Hiperostosis esquelética idiopática difusa (DISH), respecto de dos casos / Diffuse idiopathic skeletal hiperostosis, respect of two cases

La hiperostosis esquelética idiopática difusa (DISH) o enfermedad de Forestier es una patología que presenta como principal manifestación la osificación del ligamento longitudinal anterior (LLA) y la formación de puentes óseos intervertebrales. Las repercusiones otorrinolaringológicas con poca frecuencia son descritas, siendo la disfagia, la disfonía y la disnea los síntomas más comunes. Presentamos dos casos clínicos de DISH en pacientes de sexo masculino de setenta y cuatro años y otro de setenta y un años respectivamente, con disfagia de varias semanas de evolución asociado a disfonía y disnea en un caso. Realizamos la discusión de ambos casos y de las manifestaciones otorrinolaringológicas de esta patología.

Diffuse idiopathic skeletal hiperostosis (DISH) or Forester's disease is a pathology characterized by the ossification of the anterior longitudinal ligament (ALL) and the formation of intervertebral osseous bridges. The otolaryngology repercussions are rarely described, dysphagia, hoarseness and dyspnea being the most common symptoms. We present a clinical case of two patients with DISH in a 74 year-old male patient and another of 71 year-old respectively, suffering from several weeks of dysphagia associated with dysphonia and dyspnea in one case. We are going to discuss both cases together with the otolaryngological manifestations of this pathology.

[Forestier disease. Case report and literature review]. / Enfermedad de Forestier. Reporte de un caso y revisión bibliográfica.

BACKGROUND: Forestier disease is a systemic disorder characterized by ossification of the anterior spinal longitudinal ligament (ALL) in at least three adjacent vertebrae, and diffuse spinal enthesopathy. Indication for surgical treatment is rare and limited to cases of related myelopathy, fracture or significant dysphagia. Few cases of surgical treatment are reported in the medical literature. Surgical treatment depends on the particular symptoms or complications, and usually involves osteophytectomy through the standard anterior approach. Surgery may bring about complications, such as pharyngeal paralysis, thrombosis, infections and respiratory obstruction. CLINICAL CASE: 79-year old male with dysphagia of 10 years of evolution, and hoarseness and respiratory distress since 8 years ago. Screening studies showed a diffuse calcification of anterior longitudinal ligament along with large cervical osteophytes. Forestier disease and secondary dysphagia were diagnosed. Surgical treatment consisted of resection of bone exostoses in C4 and C5 vertebral bodies. Six months after surgery, the patient reported improvement of esophageal and respiratory symptoms without evidence of recurrence on imaging studies. CONCLUSIONS: Data on Forestier disease's epidemiological nature and impact on life quality in Mexico is unknown. An increase in its occurrence is projected as the Mexican population ages. An observational study is required to identify the characteristics of this disease in Mexico.

Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis.

BACKGROUND CONTEXT: Large, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up. PURPOSE: To study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH). STUDY DESIGN: Retrospective review of a case series. PATIENT SAMPLE: Five cases from a University Hospital. OUTCOME MEASURES: Clinical and imagenological follow-up. METHODS: The records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs. RESULTS: Preoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3-C4 level was involved in three cases, C4-C5 in three cases, and C5-C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes. CONCLUSIONS: Although rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered.

[Forestier disease disclosed by dysphagia. Apropos of a case]. / Maladie de Forestier révélée par une dysphagie. A propos d'une observation.

A 74-year-old man presented with a several year history of dysphagia and dysphonia. X-ray examination showed prevertebral ossification, from C2-C3 to C3-C4, associated with a calcification of the anterior longitudinal ligament. The same abnormalities were present in the thoracolumbar spine. There was no hypertrophy nor ankylosis of the articular joints or the sacroiliac articles, and no biological abnormalities. These characteristics are typical of Forestier's disease also named "diffuse idiopathic skeletal hyperostosis (DISH)". Because of the consequences of dysphagia, an operation was carried out with a good result at two months. Symptomatic forms of Forestier's disease are uncommon, but in some cases, surgery is indicated because of the importance of dysphagia and respiratory disturbances. The role of direct compression of the esophagus or the pharynx by the ossification is possible but an associated inflammatory reaction cannot be excluded.