Management of Airway Obstruction due to Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine: A Case Report and Literature Review

Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction d...

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Published inInternal Medicine Vol. 58; no. 2; pp. 271 - 276
Main Authors Yoshimatsu, Yuki, Tobino, Kazunori, Maeda, Ken, Kubota, Kensuke, Haruta, Yohei, Adachi, Hiroshi, Abe, Toshiyuki, Masunaga, Tomoka, Sueyasu, Takuto, Osaki, Toshihiro
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 15.01.2019
Japan Science and Technology Agency
Subjects
Airway management
airway obstruction
Case Report
Differential diagnosis
diffuse idiopathic skeletal hyperostosis
dysphagia
Inpatient care
Internal medicine
Literature reviews
respiratory failure
Respiratory tract
Spine (cervical)
surgery
airway obstruction
dysphagia
respiratory failure
diffuse idiopathic skeletal hyperostosis
surgery
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Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction due to exuberant osteophytosis in the cervical spine. Treatment was successful with careful airway management and surgical osteophyectomy. Most DISH cases in the literature with airway obstruction have been managed with tracheotomy. However, the safety and necessity of this approach remain questionable. We herein discuss the possibility of conservative management as a choice of airway control. Airway obstruction due to DISH may be underrecognized. This highlights the importance of including DISH in the differential diagnosis of airway obstruction. In addition, a detailed evaluation and personalized care for each individual case is essential.
AbstractList Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction due to exuberant osteophytosis in the cervical spine. Treatment was successful with careful airway management and surgical osteophyectomy. Most DISH cases in the literature with airway obstruction have been managed with tracheotomy. However, the safety and necessity of this approach remain questionable. We herein discuss the possibility of conservative management as a choice of airway control. Airway obstruction due to DISH may be underrecognized. This highlights the importance of including DISH in the differential diagnosis of airway obstruction. In addition, a detailed evaluation and personalized care for each individual case is essential.
Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction due to exuberant osteophytosis in the cervical spine. Treatment was successful with careful airway management and surgical osteophyectomy. Most DISH cases in the literature with airway obstruction have been managed with tracheotomy. However, the safety and necessity of this approach remain questionable. We herein discuss the possibility of conservative management as a choice of airway control. Airway obstruction due to DISH may be underrecognized. This highlights the importance of including DISH in the differential diagnosis of airway obstruction. In addition, a detailed evaluation and personalized care for each individual case is essential.Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction due to exuberant osteophytosis in the cervical spine. Treatment was successful with careful airway management and surgical osteophyectomy. Most DISH cases in the literature with airway obstruction have been managed with tracheotomy. However, the safety and necessity of this approach remain questionable. We herein discuss the possibility of conservative management as a choice of airway control. Airway obstruction due to DISH may be underrecognized. This highlights the importance of including DISH in the differential diagnosis of airway obstruction. In addition, a detailed evaluation and personalized care for each individual case is essential.
Author Sueyasu, Takuto
Haruta, Yohei
Masunaga, Tomoka
Adachi, Hiroshi
Osaki, Toshihiro
Tobino, Kazunori
Yoshimatsu, Yuki
Kubota, Kensuke
Abe, Toshiyuki
Maeda, Ken
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Keywords airway obstruction
dysphagia
respiratory failure
diffuse idiopathic skeletal hyperostosis
surgery
Language English
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Correspondence to Dr.　Yuki Yoshimatsu, yukitsukihana0105@gmail.com
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References 3. Resnick D, Niwajima G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119: 559-568, 1976.
7. Mader R. Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 32: 130-135, 2002.
1. Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9: 321-330, 1950.
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11. Nelson RS, Urquhart AC, Faciszewski T. Diffuse idiopathic skeletal hyperostosis: a rare cause of dysphagia, airway obstruction, and dysphonia. J Am Coll Surg 202: 938-942, 2006.
2. Vaisha R, Vijay V, Nwagbara IC. Agarwal AK. Diffuse idiopathic skeletal hyperostosis (DISH)-a common but less known cause of back pain. J Clin Orthop Trauma 8: 191-196, 2017.
9. Verlaan JJ, Boswijk PF, de Ru JA, Dhert WJ, Oner FC. Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction. Spine J 11: 1058-1067, 2011.
5. Weinfold RM, Olson PN, Maki DD, et al. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol 26: 222-225, 1997.
10. Ito K, Yoshida Y, Tachiwada T, Ito C, Awaya Y. A case of negative pressure pulmonary hemorrhage associated with tracheal obstruction resulting from ankylosing spine hyperostosis. Nihon Kokyuki Gakkaishi 3: 832-836, 2014 (in Japanese, Abstract in English).
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6. Holton KF, Denard PF, Yoo JU, et al. Diffuse idiopathic skeletal hyperostosis (DISH) and its relation to back pain among older men: the MrOS study. Semin Arthritis Rheum 41: 299-303, 2011.
4. Kim SK, Choi BR, Kim CG, et al. The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol 31: 2032-2035, 2004.
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References_xml – reference: 1. Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9: 321-330, 1950.
– reference: 11. Nelson RS, Urquhart AC, Faciszewski T. Diffuse idiopathic skeletal hyperostosis: a rare cause of dysphagia, airway obstruction, and dysphonia. J Am Coll Surg 202: 938-942, 2006.
– reference: 10. Ito K, Yoshida Y, Tachiwada T, Ito C, Awaya Y. A case of negative pressure pulmonary hemorrhage associated with tracheal obstruction resulting from ankylosing spine hyperostosis. Nihon Kokyuki Gakkaishi 3: 832-836, 2014 (in Japanese, Abstract in English).
– reference: 2. Vaisha R, Vijay V, Nwagbara IC. Agarwal AK. Diffuse idiopathic skeletal hyperostosis (DISH)-a common but less known cause of back pain. J Clin Orthop Trauma 8: 191-196, 2017.
– reference: 6. Holton KF, Denard PF, Yoo JU, et al. Diffuse idiopathic skeletal hyperostosis (DISH) and its relation to back pain among older men: the MrOS study. Semin Arthritis Rheum 41: 299-303, 2011.
– reference: 12. Bakker JT, Kuperus JS, Kujif HJ, Oner FC, de Jong PA, Verlaan JJ. Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine. PLoS One 12: e0188414, 2017.
– reference: 3. Resnick D, Niwajima G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119: 559-568, 1976.
– reference: 5. Weinfold RM, Olson PN, Maki DD, et al. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol 26: 222-225, 1997.
– reference: 8. Nascimento FA, Gatto LA, Lages RO, Neto HM, Demartini Z, Koppe GL. Diffuse idiopathic skeletal hyperostosis: a review. Surg Neurol Int 5: S122-S125, 2014.
– reference: 4. Kim SK, Choi BR, Kim CG, et al. The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol 31: 2032-2035, 2004.
– reference: 9. Verlaan JJ, Boswijk PF, de Ru JA, Dhert WJ, Oner FC. Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction. Spine J 11: 1058-1067, 2011.
– reference: 7. Mader R. Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 32: 130-135, 2002.
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SubjectTerms Airway management
airway obstruction
Case Report
Differential diagnosis
diffuse idiopathic skeletal hyperostosis
dysphagia
Inpatient care
Internal medicine
Literature reviews
respiratory failure
Respiratory tract
Spine (cervical)
surgery
Title Management of Airway Obstruction due to Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine: A Case Report and Literature Review
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