Outcomes and complications of surgical treatment of anterior osteophytes causing dysphagia: Single center experience

Clin Neurol Neurosurg. 2021 Aug:207:106814. doi: 10.1016/j.clineuro.2021.106814. Epub 2021 Jul 10.

Abstract

Study design: Retrospective case series.

Objective: To better understand the functional swallow outcomes, cervical balance, and surgical complications, we examined patients with anterior osteophytes and dysphagia who were treated operatively.

Summary of background data: Anterior osteophytes from diffuse idiopathic skeletal hyperostosis (DISH) or degenerative etiology of the cervical spine can cause dysphagia from mechanical compression of the esophagus. Osteophytectomy is generally accepted as a safe surgical treatment, but the risk of instability is unclear. The potential for associated complications must be considered.

Methods: Patients who had anterior osteophytes and dysphagia from 2005 to 2020 were reviewed retrospectively. Demographics, radiographic parameters, functional swallow outcome, and complications were examined.

Results: There were 15 patients identified treated surgically. Increased osteophyte height positively correlated with severity of dysphagia with Pearson coefficient of 0.53 (p = 0.042). Functional Outcome Swallowing Scale (FOSS) scores improved after surgical treatment from median of 2 to 0 (p = 0.002). C2-7 SVA did increase by 8 mm (p = 0.007) but was generally well tolerated. There was a 27% complication rate including a case of C5 lateral mass fracture with central cord syndrome after a fall 4 days following osteophytectomy. There was one patient who was preoperatively dependent on gastrostomy tube who required a tracheostomy and had continued reliance on the gastrostomy tube.

Conclusion: Surgical treatment of anterior osteophytes causing dysphagia with osteophytectomy can lead to overall improved FOSS scores for most patients. However, a high preoperative FOSS score may be a prognostic indicator of poor postoperative functional swallow outcome. It is important to consider the potential for instability when osteophytectomy is performed at 3 or more spinal segments.

Keywords: Anterior; Cevical; Fusion; Osteophyte; Osteophytectomy.

MeSH terms

  • Aged
  • Cervical Vertebrae
  • Deglutition Disorders / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Postoperative Complications / etiology*
  • Recovery of Function*
  • Retrospective Studies
  • Spinal Osteophytosis / complications*
  • Spinal Osteophytosis / surgery*