Images in Clinical Rheumatology
Hypertrophic anterior cervical osteophyte
Osteófito cervical anterior hipertrófico
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Pharyngeal compression by ossification of the anterior longitudinal ligament at the level of C3–C4 on a lateral cervical spine radiograph (B, arrow) and at the level of C4 in the axial plane of a computed tomography scan image at presentation (C, arrow). The distance between the tip of the osteophyte and the anterior vertebral margin was 13<span class="elsevierStyleHsp" style=""></span>mm (B, lower left).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 88-year-old man with hypertension attended an ‘basic health checkup’ and underwent annual endoscopic screening with no abnormal findings in the pharynx. At presentation, an extrinsic posterior hypo-pharyngeal mass covered by normal mucosa was found (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, arrow). Subsequent radiographs and computed tomography scans of the neck confirmed pharyngeal compression by ossification of the anterior longitudinal ligament at the level of C3–C4 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and 1C, arrow). The largest osteophyte was 13<span class="elsevierStyleHsp" style=""></span>mm wide (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B, lower left). Since he was asymptomatic, no additional studies or treatment were recommended.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">An anterior cervical osteophyte even larger than 10<span class="elsevierStyleHsp" style=""></span>mm can be asymptomatic. Dysphagia is reported to be common in patients with anterior cervical osteophytes larger than 10<span class="elsevierStyleHsp" style=""></span>mm and rare in those with smaller osteophytes<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a>), while some investigators suggest that there is no correlation between the size of the osteophyte and the development of symptoms<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>). For further understanding the causal relationship between anterior cervical osteophytes and their associated symptoms, the precise site of the osteophyte should also be taken into account; anterior cervical osteophytes protruding to right and/or left side could lead to compression of the laryngeal nerve, leading to pharyngoesophageal spasm and/or paralysis of the vocal cords<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2,4</span></a>). Clinically significant mechanical compression of the pharynx and/or esophagus at any level from C2–C7 due to anterior cervical osteophytes may induce dysphagia<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a>), and disturbances of normal epiglottis tilt over the laryngeal inlet by an osteophyte at the level of C3–C4 can cause dyspnea<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3–5</span></a>). Therefore, radiological assessment should be focused not only on the size of the osteophyte but also on the site of the osteophyte in relation to symptoms.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical committee approval</span><p id="par0015" class="elsevierStylePara elsevierViewall">None (because a case report and review of the literature is not research that must be approved by the IRB).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient and his family provided consent for submission of the case for publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding disclosure</span><p id="par0025" class="elsevierStylePara elsevierViewall">No funding received.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">All authors wrote the manuscript.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">There is no conflict of interest associated with the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical committee approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding disclosure" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contributions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-25" "fechaAceptado" => "2020-09-10" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1444 "Ancho" => 1500 "Tamanyo" => 195461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An extrinsic posterior hypo-pharyngeal mass covered by normal mucosa was found at presentation (A, arrow). Pharyngeal compression by ossification of the anterior longitudinal ligament at the level of C3–C4 on a lateral cervical spine radiograph (B, arrow) and at the level of C4 in the axial plane of a computed tomography scan image at presentation (C, arrow). The distance between the tip of the osteophyte and the anterior vertebral margin was 13<span class="elsevierStyleHsp" style=""></span>mm (B, lower left).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Miyamoto" 1 => "S. Sugiyama" 2 => "H. Hosoe" 3 => "N. Iinuma" 4 => "Y. Suzuki" 5 => "K. Shimizu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-009-1133-3" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "1652" "paginaFinal" => "1658" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19714374" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment for cervical diffuse idiopathic skeletal hyperostosis as a cause of dysphagia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Yoshioka" 1 => "H. Murakami" 2 => "S. Demura" 3 => "S. Kato" 4 => "N. Yonezawa" 5 => "N. Takahashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.22603/ssrr.2017-0045" "Revista" => array:6 [ "tituloSerie" => "Spine Surg Relat Res" "fecha" => "2018" "volumen" => "2" "paginaInicial" => "197" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31440668" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to diagnose and treat symptomatic anterior cervical osteophytes?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Lecerf" 1 => "O. 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Buonamassa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00402-001-0369-0" "Revista" => array:6 [ "tituloSerie" => "Arch Orthop Trauma Surg" "fecha" => "2002" "volumen" => "122" "paginaInicial" => "245" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12029517" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and clinical course of dysphagia caused by anterior cervical osteophyte" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.E. Choi" 1 => "G.Y. Jo" 2 => "W.J. Kim" 3 => "H.K. Do" 4 => "J.K. Kwon" 5 => "S.H. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5535/arm.2019.43.1.27" "Revista" => array:6 [ "tituloSerie" => "Ann Rehabil Med" "fecha" => "2019" "volumen" => "43" "paginaInicial" => "27" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30852868" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000009/v1_202110300812/S2173574321001817/v1_202110300812/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000009/v1_202110300812/S2173574321001817/v1_202110300812/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321001817?idApp=UINPBA00004M" ]
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