Diffuse idiopathic skeletal hyperostosis: A case of dysphagia

• Published in: Journal of manipulative and physiological therapeutics Vol. 25; no. 1; pp. 71 - 76
• Main Authors: Foshang, Trevor H., Mestan, Michael A., Riggs, Lisa J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2002
• Subjects: Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - pathology; Computed Tomography; Deglutition Disorders; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Diffuse Idiopathic Skeletal; Humans; Hyperostosis; Hyperostosis, Diffuse Idiopathic Skeletal - complications; Hyperostosis, Diffuse Idiopathic Skeletal - diagnostic imaging; Hyperostosis, Diffuse Idiopathic Skeletal - pathology; Hyperostosis, Diffuse Idiopathic Skeletal - therapy; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Diffuse Idiopathic Skeletal; Computed Tomography; Deglutition Disorders; Hyperostosis
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1067/mmt.2002.120422

Objective: To present and discuss the clinical manifestations, radiographic features, and treatment of a patient with diffuse idiopathic skeletal hyperostosis complicated by dysphagia. This case serves as an educational tool by bringing attention to an uncommon complication of a common disorder. An emphasis is placed on diagnostic imaging. Clinical Features: A 63-year-old man had dysphagia after a fall from a ladder. Plain film radiographs revealed large flowing hyperostoses arising from the anterior aspect of C3-6. Advanced imaging, consisting of a computed tomography (CT) scan and a modified barium-swallow study were performed to provide additional anatomic and functional information. Intervention and Outcome: Treatment provided by a speech and language pathologist focused on the dysphagia and consisted of compensatory management for 2½ weeks. The patient was able to successfully swallow puréed food and was released with instructions to modify his diet as tolerated. Conclusion: Dysphagia is a common clinical presentation for many disorders of deglutition. Flowing spinal hyperostoses such as that seen in diffuse idiopathic skeletal hyperostosis may become large enough to physically encroach on the pharynx or esophagus or indirectly predispose the patient to swallowing problems from posttraumatic edema. Conservative care is the initial treatment of choice, whereas surgical excision of the hyperostoses is reserved for difficult cases. (J Manipulative Physiol Ther 2002;25:71-6).