Dysphagia associated with anterior cervical protrusion – A case report

Background and Objectives Dysphagia is the medical term to describe the symptom of difficulty in swallowing.1 The possible mechanisms of dysphagia include mechanical compression to the esophagus, oro-pharyngeal tumors, retropharyngeal abscesses, peri-esophageal edema, inflammation, and anterior cervical bony outgrowths, also called osteophytes.2 Dysphagia is a common presentation in older people 3 affected by diffuse idiopathic skeletal hyperostosis (DISH) or hypertrophic anterior cervical osteophytes (HACO) associated with degenerative disc disease.4 The purpose of this report is to present the case of a 31 year-old female patient with neck pain and swallowing dysfunction. Materials and Methods This case report describes the history and physical examination of a young female complaining of neck pain and dysphagia associated with cervical disc protrusion. Results This patient presented at a physical therapy clinic with neck pain to the right side associated with swallowing dysfunction. Physical examination revealed a general restriction of the neck extension and rotation movements, ipsilateral to the painful side. However, during the physical examination, no symptom of dysphagia appeared. Due to the not common symptoms, the patient was referred for imaging assessments. The diagnosis of anterior cervical protrusion was established by magnetic resonance imaging, that revealed an anterior protrusion at C5-C6 level in association with the interruption of the anterior longitudinal ligament (Fig. 1). Moreover, Barium radiographs revealed small anterior cervical osteophytes at the C6 level characterized by a low level of calcium, causing a compression on the right posterior profile of the esophagus. Discussion: This is the first report on a cervical disc protrusion associated with a swallowing disorder in a young person, as in literature are described only few case, all of them about older people with large osteophytes.5 Conclusion Dysphagia is a condition that can occur in association with neck pain, even in young people. A comprehensive clinical examination and imaging assessment can help a clinician when uncommon symptoms are referred by a patient. It is therefore important to consider all these elements, in order to reach a correct functional diagnosis. REFERENCES 1. Brady A. Managing the patient with dysphagia.Home Healthc Nurse 2008; 26(1):41-6. 2. De Jesus-Monge WE, Cruz-Cuevas El. Dysphagia And Lung Aspiration Secondary To Anterior Cervical Osteophytes: A Case Report And Review Of The Literature. Ethn Dis 2008; 18(2 Suppl 2):S2-137-40. 3. Cook IJ. Diagnostic evaluation of dysphagia. Nature clinical practice. Gastroenterology & hepatology 2008; 5(7): 393–403. 4. Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestations. Radiology 1975; 115: 513–524. 5. Picus D, McClennan BL, Balfe DM, Roper CL, Berrigan T. Discphagia’: A Case Report. Gastrointest Radiol 1984; 9(1): 5–7.