Скачать или смотреть OSTEOPHYTES

1. Introduction
• Cervical spine osteophytes are bony outgrowths from the vertebral margins, commonly due to degenerative changes.
• Though often asymptomatic, large anterior osteophytes can compress the pharynx or esophagus, causing dysphagia and, in severe cases, aspiration.
• More common in elderly males (more than 60 years).

2. Etiology
• Degenerative spondylosis (most common)
• Diffuse Idiopathic Skeletal Hyperostosis (DISH / Forestier’s disease)
• Post-traumatic or post-surgical changes
• Congenital vertebral anomalies

3. Pathophysiology
• Anterior osteophytes from C3–C7 project towards the pharynx and esophagus.
• Mechanical compression:
• Reduces hypopharyngeal space
• Impedes epiglottic inversion
• Narrows upper esophageal sphincter (UES)
• Leads to:
• Dysphagia → pooling of secretions
• Aspiration during swallowing
• Chronic irritation → inflammation and fibrosis around UES

4. Clinical Features

Symptoms
• Progressive dysphagia (first solids, later liquids)
• Coughing or choking while eating
• Recurrent aspiration pneumonia
• Occasional odynophagia or neck pain
• Sensation of lump in throat

Signs
• Weight loss in chronic cases
• Wet voice due to aspiration
• Reduced gag reflex if neuropathy coexists

5. Diagnostic Evaluation

A. Imaging
• X-ray Cervical Spine (Lateral View) → shows anterior bony projections.
• CT scan neck → best for size, location, and relation to pharynx/esophagus.
• MRI → if neurological compression suspected.

B. Functional Tests
• Barium Swallow
• Shows indentation of pharyngeal/esophageal wall.
• Demonstrates aspiration episodes.
• Flexible Nasopharyngoscopy
• Bulging posterior pharyngeal wall.
• Pooling of secretions.
• Videofluoroscopic Swallow Study (VFSS) → gold standard for aspiration risk assessment.

6. Differential Diagnosis
• Zenker’s diverticulum
• Cricopharyngeal bar or dysfunction
• Pharyngeal or hypopharyngeal carcinoma
• Neurological dysphagia (stroke, Parkinson’s)

7. Management

A. Conservative
• Diet modification → semisolids, thickened liquids.
• Swallow therapy → positional techniques.
• Anti-reflux treatment → PPIs for associated GERD.
• Antibiotics → for aspiration pneumonia.

B. Surgical

Indicated when:
• Progressive dysphagia
• Recurrent aspiration pneumonia
• Failed conservative measures

Surgical Approach:
• Anterior cervical osteophytectomy
• Approach: Right-sided anterolateral cervical incision (Smith-Robinson approach).
• Osteophytes removed using high-speed burr or rongeurs.
• Complications:
• Recurrent laryngeal nerve injury
• Esophageal perforation
• Post-op dysphonia or dysphagia

8. Prognosis
• Good after surgery in most patients.
• Recurrence rate is low but possible, especially in DISH.
• Early detection and swallow rehabilitation reduce aspiration risk.

9. Key Takeaways
• Cervical osteophytes are a rare but important cause of aspiration.
• Always suspect in elderly patients with progressive dysphagia and recurrent aspiration.
• Videofluoroscopy + CT neck = diagnostic gold standard.
• Multidisciplinary approach: ENT + spine surgeon + speech therapist.
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