Abstract Introduction Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier disease is defined by contiguous ossification along the anterior aspect of the vertebral bodies and is usually associated with large anterior cervical ostephytes. While often asymptomatic, in certain cases this osteophytes can cause extrinsic tracheal compression, dysphagia and respiratory failure. We present the case of a severe tracheosephageal compression due to a giant c7-t1 anterior osteophyte resulting in progressive dyspnea, stridor and dysphagia. Was successfully managed with multispecialty surgical approach (neurosurgery and ENT) combined with speech language pathology rehabilitation. Case Presentation A 68 year old white male with past medical history relevant for COPD, HFpEF, HTN and morbid obesity presented with a 6 month history of progressive bilateral lower extremity pitting edema, dysphagia, voice hoarseness, shortness of breath, wheezing and inspiratory stridor. No recent trauma or prior neck surgeries. Physical examination on admission revealed bilateral lower extremity pitting edema (2+), diffuse wheezing most prominent over the upper chest, and audible inspiratory stridor on neck auscultation. Subsequently a CT scan of the neck revealed a prominent anterior osteophyte formation at C7-T1, protruding 1.9 cm beyond the anterior vertebral margin and impinging on the posterior tracheal wall with resultant narrowing of the tracheal lumen. The patient underwent successful osteophyte resection by neurosurgery but postoperatively had persistent hoarseness and dysphagia. Speech-language pathology evaluation with videofluoroscopic swallow study revealed an immobile right vocal fold with incomplete glottic closure. Otolaryngology (ENT) was consulted and performed a right vocal fold injection using Prolaryn Plus, a soft tissue bulking agent, to bulk-up the paralyzed fold and improve glottic closure. Following the procedure, the patient reported improvement in voice quality, resolution of the sensation of food getting stuck in the throat, and successful advancement of diet consistency without aspiration events. Conclusion Large anterior cervical osteophytes in DISH can cause life-threatening airway and esophageal compression (making patients prone to chronically aspirate), particularly in patients with limited ventilatory capacity (COPD, Obesity hypoventilation syndrome). This case highlights the importance of performing a thorough physical exam and early imaging in patients with progressive upper airway symptoms and dysphagia. Timely diagnosis and coordinated multidisciplinary care can significantly improve functional outcomes and prevent long-term morbidity in this complex patient population. This abstract is funded by: None
Garro et al. (Fri,) studied this question.