Swallowing difficulty in diffuse idiopathic skeletal hyperostosis with metabolic syndrome

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a disease of unknown etiology developing following ossification of the antero-lateral ligaments of the spine. Mostly, prevailing elderly adult males, it is an uncommon cause of dysphagia and dysphonia. We report three cases of DISH with metabolic syndrome. They were complained of neck movement restriction and dysphagia. At first, They all visited ear, nose, and throat outpatient department. The initial impression was gastroesophageal reflux, and an endoscopy excluded esophageal lesion. Cervical spine radiologic imaging revealed ossification of the cervical anterior longitudinal ligament with large, conspicuous osteophytes from cervical spine lesion, producing compression of pharyngoesophagus and upper airway; these images corresponded to DISH. Cervical osteophyte surgical removal resulted in a complete alleviation from dysphagia for the patient. DISH should be considered in the differential diagnosis of dysphagia.