Dysphagia caused by cervical osteophyte. Report of a case.

A woman aged forty-four was first seen in November 1970 for a feeling of a lump in the throat with dysphagia of two years’ duration. The symptoms had become steadily worse. In the past she had complained of some aching in the neck. Examination showed bulging of the posterior wall of the hypopharynx. Barium swallow radiography revealed deformation of the junction of the hypopharynx and oesophagus by a large anterior cervical bony spur (Fig. 1). There was pronounced congenital malformation of the cervical spine, with two sets of block vertebrae comprising, above, the third and fourth, and below, the fifth, sixth and seventh and first thoracic. The posterior elements corresponding to the block vertebral bodies were also fused and hypoplastic (Fig. 2). Atlas and axis were normal. The one joint in the mid-cervical spine between the fourth and fifth vertebrae was the site of degenerative changes, with a large anterior beak directed slightly to the right, postero-lateral spurring encroaching on the foramina, and sclerosis of the faceted joints with narrowing. The patient subsequently developed radicular pain in the right upper limb. There was no neurological deficit, but her difficulty in swallowing, together with the radicular pain, finally impelled the patient to accept operation. Operation and progress-Operation was undertaken at the American University Medical Centre in March 1971 . Head halter traction was set up, and an anterior collar approach was made from the right side. The affected level was easily identified by the large osteophyte. The oesophagus was deviated forwards and to the left. The intervertebral disc was very soft and fragmented. The exostosis was excised and anterior fusion carried out with an iliac bone graft without excision of the postero-lateral spurs. The course after operation was complicated by infection of a haematoma by a B haemolytic streptococcus. This responded to drainage and penicillin. The patient was discharged from hospital wearing a cervical brace. The radicular pain subsided promptly after operation. Four weeks later the patient had no neck pain and the dysphagia had improved, but it was not until eight weeks after operation that the dysphagia had disappeared. Barium swallow radiography thirteen months after operation showed the straight course of the hypopharynx and oesophagus as well as the consolidated fusion (Fig. 3).