Yonsei Med J.  2020 Apr;61(4):341-348. 10.3349/ymj.2020.61.4.341.

Surgical Outcomes of Dysphagia Provoked by Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine

Affiliations
  • 1Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 2Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea. hyzhang@nhimc.or.kr
  • 3Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. spinepjy@gmail.com

Abstract

PURPOSE
This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST).
MATERIALS AND METHODS
In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS.
RESULTS
Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020).
CONCLUSION
Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.

Keyword

Diffuse idiopathic skeletal hyperostosis; dysphagia; osteophyte

MeSH Terms

Decompression
Deglutition Disorders*
Dioctyl Sulfosuccinic Acid
Follow-Up Studies
Humans
Hyperostosis, Diffuse Idiopathic Skeletal*
Osteophyte
Recurrence
Spine*
Dioctyl Sulfosuccinic Acid
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