Multi-Level forestier syndrome in the cervical vertebra with an unusual radiographic appearance: Case report

• Main Authors: Deniz Sirinoglu (Author), Mehmet Volkan Aydin (Author), Idris Avci (Author), Gizem Meral Atiş (Author), Buse Sarıgül (Author), Mehmet Volkan Aydın (Author)
• Format: Book
• Published: International Journal of Spine Research - Peertechz Publications, 2020-01-10.
• Subjects: Case Report
• Online Access: Connect to this object online.

<p>We present a rare case of Forestier disease with multi-level vertebra involvement from the upper cervical to the thoracic area which has not been reported in the literature before.</p><p>A 65- year old male patient was admitted to our outpatient clinic with neck pain, dysphagia and sleep apnea for over 5 months. On his cervical CT scan revealed broad ossification of the anterior longitudinal ligament from C2 to T1 with anteriorly beaking osteophytes surrounding the vertebral bodies causing compression of the trachea and esophagus on C2 and C3. With the diagnosis of Diffuse Idiopathic Skeletal Hyperostosis (DISH), the patient underwent surgery. With an anterolateral approach the ossified pathological segment was removed with a high-speed drill and the patient's symptoms revealed immediately after the surgery.</p><p>Forestier disease or DISH is defined as a non-inflammatory ossification of spinal and peripheral elements. It is mostly seen in the thoracic region. In the cervical region it is mostly seen in the subaxial segment between C4-C7. Dysphagia, being the most prominent symptom in patients with cervical DISH. The fact that makes our case unique is the multiple cervical vertebra involvement of DISH starting in the upper cervical vertebra which has not been reported in the literature in this variety before.</p><p>In our patient the ossification mimicking a bird's beak had vertical growing characteristics despite being in the upper cervical area. Also, multi-level involvement in the cervical spine is rare because the cervical vertebrae are more mobile than the ones in the thoracic area. In our patient ossification from C2 to T1 was present which has not been presented in the literature before. Rapid improvement of the patient's symptoms confirmed with the radiological images strenghten the hypothesis that patients with dysphagia, especially in the ones with weight loss due to it, have better outcomes when approached surgically than conservatively</p>