Complications
Complications that may occur due to extraskeletal manifestations of DISH secondary to cervical enthesophytes include: dysphagia; dyspnoea; sleep apnoea; myelopathy; aspiration pneumonia; oesophageal obstruction; stridor; hoarseness; and thoracic outlet syndrome.[1][2][29]
For patients with dysphagia and airway issues, use a multidisciplinary approach, involving otolaryngologists and speech therapists.[1] If the dysphagia is mild, manage conservatively with dietary changes (modifying texture to soft, pureed foods), swallowing therapy, and medical management.[1] If there is airway impairment or other severe symptoms of cervical involvement, consider surgical osteophyte removal.[1][61]
For surgical resection of anterior cervical osteophytes, trans-oral, posterolateral, and anterior cervical osteophyte exposures have been used. The left anterolateral technique is frequently employed because it is surgically convenient and may reduce the risk of injury to the recurrent laryngeal nerve.[1] The anterolateral approach is particularly preferred given the ease of osteophyte removal and extended approach from C2-T1.[62] Risks associated with surgery are usually related to frailty of patients and/or distorted anatomy.[1]
Spinal stenosis as a consequence of large osteophytes may contribute to neurological compromise.
For progressive neurological symptoms, such as myelopathy or radiculopathy, consider surgical decompression.[1] Robust literature on the management of neurological symptoms in patients with DISH is lacking.
Patients with DISH are at increased risk of vertebral body fractures. DISH increases the risk of unstable spine fractures tenfold; fracture can result from low-energy mechanisms such as ground-level falls.[1][63] The most frequent fractures seen in individuals with DISH are hyperextension fractures through fused vertebral bodies; the most commonly affected segments of the spine are the cervical, thoracic, and lumbar, in that order.[1]
Fractures associated with DISH are usually managed with surgery; non-surgical management is typically reserved for individuals with medical conditions that make surgery unsuitable, as immobilisation with an orthosis alone is linked to problems such as fracture displacement with consequent neurological dysfunction and increasing deformity.[1][63]
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