Harlianto Netanja I, Kuperus Jonneke S, Mohamed Hoesein Firdaus A A, de Jong Pim A, de Ru Jacob A, Öner F Cumhur, Verlaan Jorrit-Jan
Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Spine J. 2022 Sep;22(9):1490-1503. doi: 10.1016/j.spinee.2022.03.002. Epub 2022 Mar 11.
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine.
Our previous systematic review on the epidemiological and clinical knowledge of dysphagia and airway obstruction caused by cervical DISH was updated, with a focus on (surgical) treatment and outcomes.
A systematic review of the literature was performed.
Publications in Medline and EMBASE from July 2010 to June 2021 were searched. Two investigators performed data extraction and study specific quality assessment.
A total of 138 articles (112 case reports and 26 case series) were included, describing 419 patients with dysphagia and/or airway obstruction. The mean age of the patient group was 67.3 years (range: 35-91 years), and 85.4% was male. An evident increase of published cases was observed within the last decade. Surgical treatment was chosen for 66% of patients with the anterolateral approach most commonly used. The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. Improvement of dysphagia was observed in 95.5% of operated patients. After a mean follow-up of 3.7 years (range: 0.4-9.0 years), dysphagia recurred in 12 surgically treated patients (4%), of which five patients had osteophyte regrowth.
The number of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical DISH.
弥漫性特发性骨肥厚（DISH）的特征是脊柱附着点和肌腱的骨化不断增加，当其位于颈椎前方时可能导致气管和食管受压。
对我们之前关于颈椎DISH所致吞咽困难和气道梗阻的流行病学和临床知识的系统评价进行更新，重点关注（手术）治疗及结果。
对文献进行系统评价。
检索了2010年7月至2021年6月期间Medline和EMBASE上的出版物。两名研究人员进行数据提取和研究特异性质量评估。
共纳入138篇文章（112篇病例报告和26篇病例系列），描述了419例吞咽困难和/或气道梗阻患者。患者组的平均年龄为67.3岁（范围：35 - 91岁），男性占85.4%。在过去十年中观察到已发表病例明显增加。66%的患者选择了手术治疗，最常用的是前外侧入路。术后总并发症发生率为22.1%，其中12.7%发生在干预后1个月内。95.5%的手术患者吞咽困难得到改善。平均随访3.7年（范围：0.4 - 9.0年）后，12例接受手术治疗的患者（4%）吞咽困难复发，其中5例患者有骨赘再生。
与我们之前的综述相比，过去十年中DISH患者吞咽困难的已发表病例数增加了一倍。然而，缺乏关于治疗或预防复发的随机研究或指南。手术治疗有效且（严重）并发症发生率低。我们研究中各病例确定的共同趋势可能有助于提高我们对颈椎DISH吞咽困难和气道梗阻的理解和管理。
