Osteophyte formation after multilevel anterior cervical discectomy and fusion causing a delayed presentation of functional dysphagia.

Abstract

Anterior cervical discectomy and fusion (ACDF) is a common procedure used to treat radiculopathy and myelopathy from cervical degenerative disc disease. The complications for this procedure are well known. Dysphagia can occur in the postoperative setting. However, it is typically transient and does not last longer than 1 month after an operation. A de novo presentation of dysphagia occurring years after an operation is unique. Osteophyte formation can cause mass effect on the esophagus leading to obstruction of this conduit. However, there have been no reported cases of osteophyte growth fusing to surrounding structures leading to a functional dysphagia. The authors describe a delayed presentation of functional dysphagia 9 years after an ACDF. This resulted from osteophyte formation originating from the cervical plate and tethering the thyroid cartilage and hyoid bone, thus limiting mobilization of the larynx. Case report. The osteophyte was disconnected at the origin of the plate allowing the contents of the neck to move independently. After removal of the osteophyte complex at the base of the cervical plate, this patient experienced resolution of his dysphagia. Functional dysphagia can occur in a delayed fashion after ACDF from osteophytes tethering the cervical plate to the surrounding contents of the neck used for swallowing. Freeing the contents of the neck from the tethering osteophytes can alleviate symptoms related to a dysfunctional swallowing mechanism.