• Anthony J Matan, Jack Hsu, and Bruce A Fredrickson.
• Department of Orthopedic Surgery, Spine Division, State University of New York, Upstate Medical University, 550 Harrison Street, Room 130, Syracuse, NY 13202, USA.
• Spine J. 2002 Nov 1; 2 (6): 456-9.

Background ContextDiffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH is associated with large anterior osteophytes of the cervical spine, which can cause complications by compressing adjoining structures. Dysphagia is reported in up to 28% of patients, but respiratory compromise is rare. There have been no published recommendations for treatment.PurposeTo report that resection of cervical osteophytes, without cervical fusion, can be successful in the treatment of severe respiratory distress.Study DesignThis report describes the management of a patient with DISH and severe respiratory distress resulting from large anterior cervical osteophytes.MethodsA team approach was used with collaboration between the orthopedic spine surgeons and the otolaryngologists.ResultsThis patient was found to have compression of her posterior pharyngeal wall by the osteophytes. Tracheostomy was required for the management of the airway. The patient was dependent on the tracheostomy until the osteophytes were resected. The patient was then able to breathe normally. Treatment recommendations were developed based on this case of osteophyte-induced respiratory compromise as well as the previously published accounts of osteophyte-induced dysphagia.ConclusionsAirway obstruction resulting from DISH can be treated according to the same principles as dysphagia resulting from DISH: surgical excision of osteophytes if conservative support fails.

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