Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
Department of Orthopaedic Surgery, Kagoshima Red Cross Hospital, Japan.
Spine (Phila Pa 1976). 2019 Mar 1;44(5):E269-E272. doi: 10.1097/BRS.0000000000002836.
Retrospective case control study.
To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH).
DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.
We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O-C2 angle, M-C angle, C2-7 angle, and C2-6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre- and postoperative values in the S group.
The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22-27]) compared with the NS group (1 [1-6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0-1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2-7 and ΔC2-6a, and between pre- and postoperative values in the S group. There were no significant changes in O-C2 angle and M-C angle, which are parameters of the superior cervical vertebrae.
The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.
回顾性病例对照研究。
探讨颈椎排列是否与颈椎弥漫性特发性骨肥厚症（DISH）患者的吞咽困难有关。
DISH 涉及广泛的韧带骨化，可导致吞咽困难。然而，即使是高度骨化的患者也可能只有轻度吞咽困难。吞咽困难是由于骨化导致食管受压所致；然而，吞咽困难的确切原因尚不清楚。
我们回顾了 5 例因前颈椎骨肥厚症导致严重吞咽困难而行切除术的患者（S 组），以及 5 例仅接受监测的轻度症状患者（NS 组）。采用进食评估工具-10（EAT-10）和颈椎动力位平片对患者进行评估。在屈伸中立位测量 O-C2 角、M-C 角、C2-7 角和 C2-6a 角。我们比较了 S 组与 NS 组之间的这些参数，并比较了 S 组的术前和术后值。
S 组术前 EAT-10 评分（25 [22-27]）较高，提示吞咽困难程度较高，而 NS 组（1 [1-6]）则较低。S 组术后 EAT-10 评分显著降低至 1（0-1），吞咽困难得到改善。S 组的ΔC2-7 和ΔC2-6a 以及 S 组的术前与术后值之间存在显著差异。O-C2 角和 M-C 角没有明显变化，这是颈椎上段的参数。
目前的结果表明，颈椎强直导致的颈椎活动受限可能是 DISH 患者吞咽困难的原因之一。
4 级。
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