Dysphagia following lumbar spine surgery in the setting of undiagnosed DISH of the cervical spine: a case report

Dysphagia is an often multifactorial pathology affecting many elderly patients. In addition to global neuromuscular change with normal aging, one component of its etiology may be direct compression of the pharynx or esophagus from overgrown bone from the anterior cervical spine. Diffuse idiopathic skeletal hyperostosis (DISH) is one condition that may contribute to this phenomenon. Of relatively high incidence (2.5% to 33.3%) in elderly populations, DISH has been described in the cervical spine though more frequently affects other spinal regions. The clinical case of an elderly man who developed significant dysphagia after undergoing lumbar spine surgery for spinal stenosis caused by DISH is presented. Awareness of the involvement in his cervical spine before surgery would likely have enabled a more prompt diagnosis of the etiology of dysphagia and allowed for peri-operative optimization of swallowing function to reduce morbidity. We recommend routine preoperative imaging of the cervical spine in all patients with a diagnosis of DISH to stratify risk for development of postoperative dysphagia.