Images in Clinical Rheumatology
Forestier-Rotés Querol Disease: Cervical Radiological Progression and Onset of Dysphagia
Enfermedad de Forestier-Rotés Querol: progresión radiológica cervical y aparición de disfagia
Miriam García García
Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
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A relative conservation of the height of the intervertebral disc space is also observed (2).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 68-year-old man with a personal history of Forestier-Rotés Querol disease, hypertension, type II diabetes mellitus, hepatic steatosis and Haglund's disease in right foot. He reported a worsening of the clinical signs and symptoms in cervical spine over the preceding year, with continuous pain and progressive limitation for movements from side to side, and no evidence of radiculopathy or myelopathy. He also complained of dysphagia with solid food and, to a lesser extent, with liquids, and had lost 15<span class="elsevierStyleHsp" style=""></span>kg over the preceding year.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The involvement of cervical spine in this disease and the development of dysphagia has been documented previously. However, the purpose of presenting this case report is to show the radiological progression over a 5-year period in the same patient and its clinical impact.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The radiographic changes in Forestier-Rotés Querol disease were described by Resnick in 1975.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> These criteria include the ossification of the anterior longitudinal ligament along the anterolateral surface of at least 4 contiguous vertebral bodies, the preservation of disc height, the absence of the vacuum phenomenon or marginal sclerosis in the vertebral bodies and the absence of ankylosis of the facet joints or changes in the sacroiliac joints.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The assessment of the radiological changes in the cervical spine of this patient over a 5-year period revealed an increase in osteophyte size and in the ossification of anterior cervical ligament, which affected several contiguous vertebrae (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). This could explain an extrinsic cause of the dysphagia. There are other radiological features of interest, such as the relative preservation of the intervertebral disc space and the absence of involvement of the facet joints.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given the systemic signs, the patient underwent gastroscopy and upper gastrointestinal series, the results of which were normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Computed tomography of the cervical spine revealed ossification of anterior longitudinal ligament and anterior osteophytes, with involvement basically in the upper cervical spine (C2–C4), which made forward motion of the aerodigestive tract more difficult. There was no evidence of involvement of the facet joints.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, dysphagia is a relatively common manifestation when the cervical anterior longitudinal ligament is affected.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> In the differential diagnosis, it is necessary to rule out both an intrinsic and an extrinsic component, since the most frequent causes of dysphagia continue to be tumors.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> For treatment, a conservative approach should be adopted (analgesia, rehabilitation, suitable nutritional intake and monitoring for metabolic syndrome, which is closely related to Forestier disease)<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4–7</span></a> and, in more serious cases, the compression produced by the osteophytes may require surgical intervention.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> However, there is a high percentage of recurrences following surgery.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author declares that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author declares that she has followed the protocols of her work center on the publication of patient data and that all the patients included in the study have been properly informed and have given their written consent to participate in said study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author has obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author declares that she has no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-04" "fechaAceptado" => "2015-10-30" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García García M. Enfermedad de Forestier-Rotés Querol: progresión radiológica cervical y aparición de disfagia. Reumatol Clin. 2016;12:292–293.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2136 "Ancho" => 1583 "Tamanyo" => 208629 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiography of lateral cervical spine (2009) showing ossification of anterior cervical ligament, which has a greater effect on the lower cervical segment (1). The intervertebral disc spaces (2) and facet joints are conserved (3).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2008 "Ancho" => 1583 "Tamanyo" => 167173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Radiography of lateral cervical spine (2014) showing an increase in the extent of ossification of anterior cervical ligament with overall involvement of the cervical spine (1), and a protuberance (*) toward the aerodigestive tract. A relative conservation of the height of the intervertebral disc space is also observed (2).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Resnick" 1 => "S.R. Shaul" 2 => "J.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 11 | 20 |
| 2024 October | 61 | 38 | 99 |
| 2024 September | 81 | 27 | 108 |
| 2024 August | 88 | 34 | 122 |
| 2024 July | 74 | 24 | 98 |
| 2024 June | 88 | 41 | 129 |
| 2024 May | 73 | 33 | 106 |
| 2024 April | 60 | 22 | 82 |
| 2024 March | 86 | 24 | 110 |
| 2024 February | 68 | 29 | 97 |
| 2024 January | 57 | 21 | 78 |
| 2023 December | 46 | 28 | 74 |
| 2023 November | 68 | 34 | 102 |
| 2023 October | 78 | 24 | 102 |
| 2023 September | 58 | 30 | 88 |
| 2023 August | 58 | 24 | 82 |
| 2023 July | 58 | 32 | 90 |
| 2023 June | 57 | 18 | 75 |
| 2023 May | 52 | 26 | 78 |
| 2023 April | 54 | 12 | 66 |
| 2023 March | 107 | 27 | 134 |
| 2023 February | 71 | 29 | 100 |
| 2023 January | 84 | 39 | 123 |
| 2022 December | 70 | 31 | 101 |
| 2022 November | 83 | 27 | 110 |
| 2022 October | 61 | 38 | 99 |
| 2022 September | 45 | 27 | 72 |
| 2022 August | 76 | 38 | 114 |
| 2022 July | 64 | 30 | 94 |
| 2022 June | 63 | 32 | 95 |
| 2022 May | 60 | 26 | 86 |
| 2022 April | 72 | 30 | 102 |
| 2022 March | 60 | 47 | 107 |
| 2022 February | 102 | 20 | 122 |
| 2022 January | 116 | 30 | 146 |
| 2021 December | 62 | 35 | 97 |
| 2021 November | 53 | 40 | 93 |
| 2021 October | 64 | 51 | 115 |
| 2021 September | 77 | 28 | 105 |
| 2021 August | 83 | 36 | 119 |
| 2021 July | 39 | 35 | 74 |
| 2021 June | 55 | 29 | 84 |
| 2021 May | 66 | 48 | 114 |
| 2021 April | 114 | 99 | 213 |
| 2021 March | 57 | 16 | 73 |
| 2021 February | 43 | 19 | 62 |
| 2021 January | 47 | 26 | 73 |
| 2020 December | 97 | 17 | 114 |
| 2020 November | 48 | 25 | 73 |
| 2020 October | 26 | 14 | 40 |
| 2020 September | 61 | 28 | 89 |
| 2020 August | 38 | 18 | 56 |
| 2020 July | 26 | 14 | 40 |
| 2020 June | 36 | 16 | 52 |
| 2020 May | 24 | 16 | 40 |
| 2020 April | 21 | 14 | 35 |
| 2020 March | 11 | 7 | 18 |
| 2019 August | 2 | 0 | 2 |
| 2019 March | 2 | 4 | 6 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 5 | 2 | 7 |
| 2018 April | 42 | 6 | 48 |
| 2018 March | 54 | 12 | 66 |
| 2018 February | 43 | 6 | 49 |
| 2018 January | 19 | 4 | 23 |
| 2017 December | 29 | 8 | 37 |
| 2017 November | 38 | 8 | 46 |
| 2017 October | 25 | 6 | 31 |
| 2017 September | 28 | 5 | 33 |
| 2017 August | 39 | 10 | 49 |
| 2017 July | 35 | 15 | 50 |
| 2017 June | 39 | 14 | 53 |
| 2017 May | 48 | 12 | 60 |
| 2017 April | 46 | 13 | 59 |
| 2017 March | 33 | 12 | 45 |
| 2017 February | 24 | 7 | 31 |
| 2017 January | 23 | 6 | 29 |
| 2016 December | 51 | 17 | 68 |
| 2016 November | 41 | 20 | 61 |
| 2016 October | 91 | 34 | 125 |
| 2016 September | 77 | 15 | 92 |
| 2016 August | 24 | 3 | 27 |
| 2016 July | 2 | 0 | 2 |
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