• Giuseppe Roberto Giammalva, Domenico Gerardo Iacopino, Francesca Graziano, Carlo Gulì, Maria Angela Pino, and Rosario Maugeri.
• Unit of Neurosurgery, AOUP "Paolo Giaccone", Postgraduate School in Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, University of Palermo, Palermo, Italy.
• Surg Neurol Int. 2018 Jan 1; 9: 236.

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a rheumatologic condition characterized by ossification of the spinal ligaments and tendons. Large anterior osteophytes are typically present in the lower cervical levels, while upper cervical ossification resulting in dysphagia is very rare.MethodsHere, we presented a patient with Forestier's disease involving massive ossification of the anterior longitudinal ligament extending from C3 to C4 downward contributing to severe dysphagia.ResultsA 65-year-old male presented with cervical pain and dysphagia. The computed tomography of the cervical spine demonstrated massive anterior longitudinal ligament ossification (DISH) extending from C3 to C7. There was an additional large osteophyte at the C3-C4 level, and also a high-grade intracanalicular C6-C7 cervical stenosis due to ossification of the posterior longitudinal ligament. The patient was offered surgical intervention (e.g., resection of the C3-C7 anterior DISH and anterior cervical discectomy/fusion at the C6-C7 level), but he declined.ConclusionsWhen conservative management fails to resolve severe dysphagia for cervical DISH/Forestier's disease, anterior surgical resection is typically performed. In this case, the patient refused surgery and opted for conservative management strategies.

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