Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction.
BACKGROUND
Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed condition relating to ossification of spinal ligaments that can cause compression of the esophagus and trachea. According to case reports, dysphagia or airway obstruction resulting from DISH is a rare occurrence.


OBJECTIVE
This study was intended to identify all published cases of dysphagia and/or airway obstruction resulting from DISH to increase the epidemiologic/clinical knowledge of these related conditions.


METHODS
A systematic review of the literature was performed.


METHODS
The articles resulting from the systematic PubMed/EMBASE search of the literature were closely read, and predefined parameters were scored.


RESULTS
The search yielded a total of 118 articles (95 case reports and 23 case series) describing 204 patients with dysphagia and/or airway obstruction resulting from DISH. The number of cases demonstrated a steady increase from 1980 to 2009. This might be a real effect not ascribable to publication bias or expansion of the medical literature alone.


CONCLUSIONS
Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon. Diffuse idiopathic skeletal hyperostosis should be included in the differential diagnosis of dysphagia and airway obstruction.
Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands. j.j.verlaan@umcutrecht.nl
Jorrit-Jan
JJ
Verlaan
Petronella F E
PF
Boswijk
Jacob A
JA
de Ru
Wouter J A
WJ
Dhert
F Cumhur
FC
Oner
D000402:Airway Obstruction / Q000209:etiology*; D002574:Cervical Vertebrae; D003680:Deglutition Disorders / Q000209:etiology*; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications*