Anterior Cervical Osteophytectomy for Dysphagia: A Retrospective Case Series and Literature Review of Post Operative Outcomes Based on Duration of Symptoms

Introduction: Diffuse idiopathic skeletal hyperostosis effects approximately 10-20% of the population with 2-6% of them having associated dysphagia secondary to ventral cervical osteophyte complexes. While mechanical compression can be alleviated with a ventral cervical ostophytectomy (VCO) post-surgical results vary likely secondary to damage to the enteric plexus. Enteric plexus damage is irreversible and thought to occur secondary to prolonged compression and mechanical esophageal trauma overtime from the osteophyte complex. To improve post-surgical outcomes, it is necessary to delineate an optimal timeline of decompression from symptom onset before enteric plexus damage occurs.

Methods: A comprehensive literature review using PubMed was performed to evaluate VCO post-surgical outcomes based on onset of symptoms to timing of surgery. A retrospective analysis was then performed on our single center VCO database. Outcomes were focused on post-surgical subjective improvement in dysphagia based on timing to surgery.

Results: 159 patients were identified from the literature search and our center’s database who underwent VCO for symptomatic dysphagia. Onset of symptoms to surgery timing was available for 30 patients. Average timing from onset of symptoms to surgery was 19.2 months with a range of 6 – 72 months. Symptomatic improvement in swallowing was subjectively noted in 96% (29 patients) of those undergoing surgery. One patient who underwent surgery 72 months after symptom onset reported no benefit in symptomatic dysphagia.

Conclusion : While alleviating mechanical compression of the esophagus has demonstrated symptomatic improvement in patients, more data is required to determine optimal surgical timing before irreversible enteric plexus damage occurs.