Wu Jian, Shao Wei, Zhu Wenqing, Mo Jianwen
The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China.
Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
Front Surg. 2025 Jun 26;12:1609708. doi: 10.3389/fsurg.2025.1609708. eCollection 2025.
Cervical spondylotic dysphagia (CSD) and cervical spondylotic myelopathy (CSM) represent two distinct clinical entities within degenerative cervical pathology. Their co-occurrence creates diagnostic and therapeutic dilemmas due to overlapping pathophysiological mechanisms. CSD primarily stems from anterior cervical osteophytes mechanically compressing the esophageal lumen, resulting in progressive dysphagia and pharyngeal discomfort. Conversely, CSM develops through spinal cord compression mediated by posterior osteophytic growth, intervertebral disc herniation, or ossification of the posterior longitudinal ligament (OPLL), clinically manifesting as limb paresthesia, motor weakness, gait instability, and impaired manual dexterity. We describe a 58-year-old male presenting with progressive dysphagia accompanied by bilateral lower extremity weakness. Radiological evaluation demonstrated prominent anterior osteophytes with bridging syndesmophytes at C4-C6 levels causing posterior pharyngeal wall displacement, concurrent with C3-C7 OPLL and multilevel disc herniations inducing spinal cord compression. Surgical management comprised anterior cervical osteophytectomy via a standard Smith-Robinson approach, followed by two-level anterior cervical discectomy and fusion (ACDF) utilizing a zero-profile interbody cage system, achieving dual objectives of spinal canal decompression and segmental stabilization. The patient exhibited complete dysphagia resolution and substantial neurological recovery during postoperative follow-up.
颈椎病性吞咽困难（CSD）和颈椎病性脊髓病（CSM）是退行性颈椎病变中的两种不同临床病症。由于病理生理机制重叠，它们的同时出现带来了诊断和治疗上的难题。CSD主要源于颈椎前缘骨赘机械性压迫食管腔，导致进行性吞咽困难和咽部不适。相反，CSM是由后缘骨赘生长、椎间盘突出或后纵韧带骨化（OPLL）介导的脊髓受压发展而来，临床表现为肢体感觉异常、运动无力、步态不稳和手部灵活性受损。我们描述了一名58岁男性，表现为进行性吞咽困难并伴有双侧下肢无力。影像学评估显示，C4 - C6水平有明显的前缘骨赘并伴有连接性骨桥，导致咽后壁移位，同时存在C3 - C7 OPLL和多节段椎间盘突出，引起脊髓受压。手术治疗包括通过标准的史密斯-罗宾逊入路进行颈椎前缘骨赘切除术，随后使用零切迹椎间融合器系统进行两节段颈椎前路椎间盘切除融合术（ACDF），实现了椎管减压和节段稳定的双重目标。术后随访期间，患者吞咽困难完全缓解，神经功能显著恢复。
