• Amer Sebaaly, Ghassan Boubez, Tarek Sunna, Zhi Wang, Elie Alam, Apostolos Christopoulos, and Daniel Shedid.
• Department of Orthopedic Surgery, Centre Hopitalier de l'Université de Montréal, Montréal, Quebec, Canada; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. Electronic address: amersebaaly@hotmail.com.
• World Neurosurg. 2018 Mar 1; 111: 79-85.

BackgroundDiffuse idiopathic hyperostosis (DISH) is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. This disease is mainly asymptomatic but cervical osteophytes can sometimes cause dysphagia (DISHphagia), hoarseness, and even dyspnea.Case DescriptionWe report, for the first time in the medical literature, a case of a 76-year-old patient with DISH causing an important dysphagia as well as bilateral vocal cord paralysis causing critical dyspnea. The patient was surgically treated by anterior resection of the osteophytes and application of bone wax, with significant clinical improvement and no radiologic recurrence after 2 years of follow-up.Discussion And ConclusionA thorough literature review didn't yield any article reporting on bilateral vocal cord paralysis caused by DISH. Management of this condition is typically multidisciplinary, and treatment of cervical osteophyte-associated dysphagia or respiratory compromise is primarily medical, after performing necessary tests to rule out other causes of dysphagia. Surgical intervention is warranted when medical treatment fails, when there is weight loss, a significant airway compromise or sleeping alterations. A treatment algorithm is proposed in the end of this review for symptomatic anterior osteophytes caused by DISH in the mobile cervical spine.Copyright © 2017 Elsevier Inc. All rights reserved.

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