Oppenlander Mark E, Orringer Daniel A, La Marca Frank, McGillicuddy John E, Sullivan Stephen E, Chandler William F, Park Paul
University of Michigan Medical School, Ann Arbor, MI, 3552 Taubman Center, Box 0338, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
Surg Neurol. 2009 Sep;72(3):266-70; discussion 270-1. doi: 10.1016/j.surneu.2008.08.081. Epub 2009 Jan 14.
Anterior cervical hyperosteophytosis describes the excessive formation of osteophytes along the ventral spine. Dysphagia due to ACH is considered an uncommon entity described mainly in case reports. Symptomatic ACH has been attributed to multiple etiologies including DISH, trauma, postlaminectomy syndromes, and cervical spondylosis. We report one of the largest series of patients with ACH-induced dysphagia requiring surgery.
After IRB approval, a retrospective chart review was completed. From 2001 to 2006, 9 patients presented with dysphagia due to ACH requiring surgical treatment.
Eight patients were male, and the mean age was 65.1 years. Cervical spine x-rays and CT clearly demonstrated ACH in each case. Esophagram or a video fluoroscopic swallowing study was used to verify that dysphagia was caused by osteophytic overgrowth in all instances but one. In 2 patients, a focal osteophyte had formed adjacent to a previously fused segment. Of the remaining 7 patients, osteophytic formation was attributed to cervical spondylosis in 2 patients and DISH in 5 patients. All patients underwent osteophytectomy without spinal fusion. Average follow-up was 9.8 months. Although all 9 patients experienced resolution of dysphagia, improvement was delayed in 2 patients.
Diffuse idiopathic skeletal hyperostosis and spondylosis are the most common etiologies accounting for ACH-induced dysphagia. Adjacent segment disease may also be a potential cause of symptomatic ACH and has not been previously reported. Regardless of etiology, surgical resection is highly successful if conservative measures fail.
颈椎前路骨质增生是指沿椎体腹侧过度形成骨赘。由颈椎前路骨质增生引起的吞咽困难被认为是一种罕见病症，主要在病例报告中有所描述。有症状的颈椎前路骨质增生的病因多种多样，包括弥漫性特发性骨肥厚、创伤、椎板切除术后综合征和颈椎病。我们报告了一系列因颈椎前路骨质增生导致吞咽困难而需要手术治疗的患者中规模最大的一组病例。
经机构审查委员会批准后，完成了一项回顾性病历审查。2001年至2006年期间，9例因颈椎前路骨质增生导致吞咽困难而需要手术治疗的患者前来就诊。
8例为男性，平均年龄65.1岁。颈椎X线片和CT在每个病例中均清晰显示颈椎前路骨质增生。除1例患者外，所有病例均通过食管造影或视频透视吞咽研究证实吞咽困难是由骨赘过度生长引起的。2例患者在先前融合节段附近形成了局灶性骨赘。在其余7例患者中，2例患者的骨赘形成归因于颈椎病，5例患者归因于弥漫性特发性骨肥厚。所有患者均接受了骨赘切除术，未进行脊柱融合。平均随访时间为9.8个月。尽管所有9例患者的吞咽困难均得到缓解，但2例患者的改善出现延迟。
弥漫性特发性骨肥厚和颈椎病是颈椎前路骨质增生导致吞咽困难最常见的病因。相邻节段疾病也可能是有症状的颈椎前路骨质增生的潜在原因，此前尚未见报道。无论病因如何，如果保守治疗失败，手术切除非常成功。
