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At least 19 recordsLinked to original sources

PubMed2003

Arthroscopic removal of a loose body osteophyte fragment after superior patellar dislocation with locked osteophytes.

The authors report the case of a loose body from a fractured osteophyte after a superiorly dislocated patella with locked osteophytes. Few cases of superiorly dislocated patellae have been reported in the literature and no cases of osteophyte fracture fragments after locked osteophytes with subsequent arthroscopic loose body removal have been reported. The loose body was removed and the distal pole of the patella was debrided arthroscopically. This patient and the majority of previously reported cases, herein reviewed, had patella alta with pre-existing patellofemoral arthrosis. Patella alta in the face of patellofemoral arthrosis should be considered a risk factor for loose body formation. Therefore, recurrent superior patellar dislocation and locking osteophytes may be a relative indication for pre-emptive arthroscopic debridement of locked osteophytes.

Arthroscopy↗

PubMed1993

Cartilage destruction and osteophytes in instability-induced murine osteoarthritis: role of TGF beta in osteophyte formation?

Osteoarthritis is characterized by focal cartilage destruction and marked formation of osteophytes. We have investigated the possible relationship between site specific occurrence of cartilage damage and osteophytes in the collagenase induced murine osteoarthritis model. The degree of instability of the joint correlated with the amount of cartilage loss. Moreover, cartilage damage in the medial tibial plateau correlated only strongly with the osteophyte at the medial plateau, whereas a similar, site directed trend was noted for lateral damage and lateral osteophytes. A separate study with intraarticular injection of TGF beta 1 in normal murine knee joints revealed that this factor can induce osteophytes at characteristic sites, suggesting a role of endogenous TGF beta in this phenomenon.

Animals↗

PubMed2001

Central osteophytes in the knee: prevalence and association with cartilage defects on MR imaging.

OBJECTIVE: The objective of this study was to determine the prevalence and location of central osteophytes in patients referred for MR imaging of the knee and the relationship of central osteophytes to articular cartilage defects, marginal osteophytes, meniscal tears, and anterior cruciate ligament tears as seen on MR imaging. MATERIALS AND METHODS: Two hundred consecutive patients referred for MR imaging of the knee were evaluated for central osteophytes, articular cartilage defects, marginal osteophytes, meniscal tears, and anterior cruciate ligament tears. A 1.5-T scanner was used, and assessments were made by consensus of two experienced musculoskeletal radiologists. Seven patients were excluded, leaving 193 patients in the study population. RESULTS: The prevalence of central osteophytes in the knee was 15% (35 central osteophytes in 29 patients). Patients with central osteophytes were older (mean age, 52 years versus 38 years), weighed more (mean weight, 204 lb [92 kg] versus 174 lb [78 kg]), had more articular cartilage defects (mean, 4.3 versus 1.3), and had more marginal osteophytes (mean, 3.9 versus 1.1) than patients without central osteophytes (p < 0.0001, Student's t test). Patients with central osteophytes were more likely to have a meniscal tear (p = 0.004, chi-square test), but they were not more likely to have an anterior cruciate ligament tear. All central osteophytes were associated with articular cartilage defects at the same location, which were full or near-full thickness on MR imaging for 32 of 35 central osteophytes. CONCLUSION: Central osteophytes are common in patients referred for MR imaging of the knee. When central osteophytes are seen in the knee there is a high likelihood of an associated full thickness or near-full thickness articular cartilage defect.

Adult↗

PubMed2003

Topographical and histological examination of osteophytes taken from arthrotic femoral heads.

Until now it is not known whether osteophytes of the femoral head develop because of pathological joint alterations or arise from normal remodeling processes secondary to osteoarthrosis. Firstly, we analysed the topographical localization of osteophytes. We then compared the extracellular matrix components of macroscopically normal cartilage from the margin of osteophytes with osteophytic cartilage from weight bearing and non-weight bearing zones by histochemical staining of low and heavily sulfated glycosaminoglycans. For examination 65 femoral heads were taken during endoprosthetic hip surgery. Osteophytes from different locations and macroscopically normal cartilage from the margin of osteophytes were excised, decalcified and embedded in paraplast. A lateral or medial localization of osteophytes (47 cases) was more common than a ventral or dorsal position (18 cases). Histochemical staining for low and heavily sulfated glycosaminoglycans from normal cartilage at the rim of osteophytes was stronger in the unmineralized cartilaginous zones compared to the mineralized cartilaginous zone. Weight bearing zones of osteophytic cartilage, on the other hand, showed an even distribution of the two differently sulfated glycosaminoglycans. Surprisingly, non-weight bearing zones of osteophytic cartilage showed a weaker staining for low and especially for heavily sulfated glycosaminoglycans in the superficial cartilage layer than in the deep cartilage layer. Altogether, osteophytic cartilage can be regarded as a reparative phenomenon for two reasons: Firstly, osteophytes arise very often at the weight bearing lateral and medial femoral head. Secondly, despite local differences in osteophytic cartilage, the same types of glycosaminoglycans are synthesized as in normal cartilage at the margin of osteophytes.

Aged↗

PubMed2004

Osteophytes and progression of knee osteoarthritis.

OBJECTIVES: Osteophytes are thought to stabilize an osteoarthritic joint, thereby preventing structural progression. Meagre longitudinal data suggest, however, that they are associated with an increased risk of structural progression. Our objective was to evaluate the effect of osteophyte size on radiographic progression in osteoarthritis (OA). METHODS: Using data from a natural history study of persons with symptomatic knee OA, we obtained fluoroscopically positioned postero-anterior (PA) radiographs at baseline, 15 and 30 months. Using an atlas, osteophyte size was scored on a scale of 0-3 at each of four sites on the PA film and, for each knee, both compartment-specific (i.e. medial; lateral) and overall osteophyte scores were computed. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semiquantitative grading. Mechanical alignment was assessed using long limb films at the 15 month examination. Logistic regression was used to evaluate the relation of osteophyte size with progression, adjusting for age, gender and body mass index, and with and without adjustment for alignment. RESULTS: Of 270 subjects who had 470 eligible knees with follow-up, 104 (22%) knees showed progression. Overall, osteophyte score modestly increased the risk of progression [odds ratio (OR) per S.D. increase of osteophyte score=1.4 (95% CI 1.1, 1.8, P=0.02)], but this effect weakened and became non-significant after adjustment for limb alignment (OR=1.3). Compartment osteophyte score was strongly associated with malalignment to the side of the osteophyte (e.g. medial osteophyte and varus). Compartment-specific osteophyte score markedly increased the risk of ipsilateral progression (e.g. medial osteophytes --> medial progression) [OR per S.D.=1.9 (95% CI 1.5, 2.5, P<0.001)] and decreased the risk of contralateral progression [OR per S.D.= 0.6 (95% CI 0.5, 0.8, P=0.002)], but these associations diminished when we adjusted for limb alignment (OR=1.5 and 0.7 respectively). CONCLUSIONS: Large osteophytes do not affect the risk of structural progression. They are strongly associated with malalignment to the side of the osteophyte, and any relation they have with progression is partly explained by the association of malalignment with progression.

Aged↗

PubMed2002

Characterisation of size and direction of osteophyte in knee osteoarthritis: a radiographic study.

OBJECTIVES: To examine the size and direction of osteophyte in knee osteoarthritis (OA) and to determine associations between osteophyte size and other radiographic features. METHODS: Knee radiographs (standing extended anteroposterior and 30 degrees flexion skyline views) were examined from 204 patients referred to hospital with symptomatic knee OA (155 women, 49 men; mean age 70, range 34-91 years). A single observer assessed films for osteophyte size and direction at eight sites; narrowing in each compartment; varus/valgus angulation; patellofemoral subluxation; attrition; and chondrocalcinosis using a standard atlas, direct measurement, or visual assessment. For analysis, one OA knee was selected at random from each subject. RESULTS: Osteophyte direction at the eight sites was divisible into five categories. At all sites, except for the lateral tibial plateau and the medial patella, osteophyte direction varied according to (a) the size of osteophyte and (b) the degree of local narrowing. At the medial femur, medial tibia, and lateral femur osteophyte direction changed from being predominantly horizontal to predominantly vertical with increasing size. The size of osteophyte correlated positively with the severity of local narrowing, except for the medial patellofemoral compartment where osteophyte size correlated positively with the severity of narrowing in the medial tibiofemoral compartment. Logistic regression analysis showed that osteophyte size was associated not only with local narrowing but also with local malalignment and bone attrition, and that chondrocalcinosis was positively associated with osteophyte size at multiple sites. CONCLUSION: In patients referred to hospital with knee OA different patterns of osteophyte direction are discernible. Osteophyte size is associated with local compartmental narrowing but also local alignment and attrition. Chondrocalcinosis is associated with osteophytosis throughout the joint. These data suggest that both local biomechanical and constitutional factors influence the size and direction of osteophyte formation in knee OA.

Adult↗

PubMedDate not supplied

The ultrastructure of the peri-articular osteophytes - an evaluation by scanning electron microscopy.

OBJECTIVE: Osteophytes are intra-articular osteochondral tissues, which are usually found at the margins of degenerating synovial joints. The aetiology or pathogenesis of this tissue has been a subject of protracted debate. The aim of this study was to offer a possible aetiology and or pathogenesis of this expendable yet important osteochondral tissue using the scanning electron microscopy to evaluate the structure of the cartilage mantle of osteophytes and the relationship of this mantle with that of the adjoining normal articular cartilage. METHODS: Sections of periarticular osteophytes and osteophyte-normal articular cartilage composite tissues were obtained during total knee replacement for osteoarthritis (OA). These sections were routinely processed and examined using the scanning electron microscope with emphasis on the osteophytic cartilage mantle and the merger of the osteophyte and the adjoining normal articular cartilage. RESULTS: The cartilage mantle of osteophytes was found to be thinner but continuous with that of the adjoining normal articular cartilage. However, a longitudinal bar of acellular tissue was found to separate the subchondral bones of both tissues. The cellular (chondrocyte) arrangement in the osteophytic cartilage was similar to that of the adjoining normal articular cartilage. In addition, in the superficial layer, there was looping of collagen fibres between the normal articular cartilage mantle and that of the osteophytic tissues. CONCLUSION: The continuity between the cartilage mantle of osteophytes and the adjoining normal articular cartilage may suggest that in the formation of osteophytes, the chondrocytes from the adjoining normal articular cartilage greatly influence the mesenchymal tissue precursor of osteophyte to differentiate along a chondrocytic pathway initially. With subsequent vascular invasion probably from the periosteum, the neocartilage develops a bony core with a completely separate blood supply from that of the adjoining subchondral bone.

Aged↗

PubMed2006

High signal in knee osteophytes is not associated with knee pain.

OBJECTIVE: Our understanding of the local source of pain in osteoarthritis (OA) remains unclear. We undertook this study to determine if the presence of high-signal osteophytes on magnetic resonance imaging (MRI) was associated with pain presence, location or severity. METHODS: Subjects were chosen from the Boston Osteoarthritis of the Knee Study, a natural history study of symptomatic knee OA. Assessments included knee MRI, pain assessments and information on weight and height. Osteophyte signal was defined as areas of increased signal intensity in the osteophyte on fat-suppressed T2 weighted images, and graded in the joint margins where osteophyte size is graded. All patients were evaluated with the frequent knee symptoms question for pain presence, the Western Ontario McMasters Osteoarthritis Index (WOMAC) for pain severity, and location of self-reported pain was recorded as present or absent based on locations identified on a standardized diagram. The osteophyte signal measures anywhere within one given knee were summed, creating an osteophyte signal aggregate. Logistic regression was conducted with quartile of osteophyte signal aggregate as the independent predictor and frequent knee symptom question as the dependent outcome. Association between quartile of osteophyte signal aggregate and pain severity on WOMAC was assessed using a linear regression. Logistic regression was used to evaluate the association between compartment-specific high-signal osteophytes aggregates (independent variable) and compartment-specific knee pain (dependent variable). Analyses were adjusted for gender, body mass index (BMI), and age. RESULTS: Two hundred and seventeen subjects were included in this analysis. They were predominantly male and 75% of subjects had radiographic tibio-femoral (TF) OA, and the remainder had patello-femoral (PF) radiographic OA. We did not find any association of high-signal osteophytes with presence of pain, pain severity or self-reported pain location. CONCLUSION: High-signal osteophytes detected on MRI are not associated with the presence of pain, pain severity or the self-reported location of pain.

Aged↗

PubMed2003

Lack of association between lumbar disc degeneration and osteophyte formation in elderly japanese women with back pain.

Our study was designed to assess the contributions of the physical and constitutional factors to osteophyte formation, disc degeneration, and bone mineral density (BMD) in lumbar vertebrae of elderly postmenopausal women. A total of 126 Japanese women with back pain, aged over 60 years, were invited to participate in the study. Then 80 subjects with a full set of data for physical examinations, radiographs, MRI, and DXA were examined. TaqI polymorphism of vitamin D receptor (VDR) gene was examined in 60 subjects. Prevalence rates of osteophytes (on radiographs) and disc degeneration (on MRI) were 61 and 68%, respectively. Body weight and BMI correlated significantly with anteroposterior (AP) and lateral (LAT) BMD (r = 0.354 for weight, r = 0.347 for BMI) and mean osteophyte area (r = 0.557 for weight, r = 0.486 for BMI), and body weight also correlated with number of discs with osteophytes. However, these did not correlate with the disc area or the number of degenerated discs. Stepwise regression analysis revealed that body weight and LAT-BMD values independently related to the osteophyte area. Disc area (r = 0.386 for AP view) and osteophyte area (r = 0.384 for AP view) significantly correlated with BMD. However, disc area and osteophyte area did not correlate with each other (r = 0.056). The proportion of degenerated discs was higher in the lower lumbar discs, but not the proportion of discs with osteophytes. Frequencies of T and t alleles of VDR did not correlate with disc degeneration, osteophyte formation, or osteoporosis. Our data showed that increases in osteophyte formation and BMD in the lumbar vertebrae are influenced by body weight and BMI, but did not correlate with disc area, which correlated inversely with BMD. Disc degeneration and osteophyte formation seem to represent two different factors that affect lumbar spine in elderly women.

Aged↗

PubMed1994

[Osteophyte formation in the knee joint: a radiological study].

Reported here are the results of a study on the significance of osteophyte formation in the osteoarthritic knee joint. The osteophyte formation was examined in a total of 795 cases involving 1040 joints. Of these, 415 cases (660 joints) had no symptoms of osteoarthritis of the knee joint (Group A); while the other 380 (380 joints) had primary osteoarthritis of the knee joint (Group B). The osteophyte location and osteophyte length were determined in all cases of Group A and Group B. The rate of annual increase in osteophyte length was determined in 224 cases (369 joints) of Group A (average study period: 7.1 years) and in 122 cases (122 joints) of Group B (average study period: 7.5 years). A special measuring unit called the "spur index" was devised for the present study to determine a corrected measurement of the osteophyte length; 1 spur index unit corresponded to 1/100 of the width of the proximal tibial articular surface. By using this spur index, measurements could be corrected for the magnifying effect of X-ray photography and for variations in the size of knee joints. On the assumption that age, obesity, arteriolosclerosis and femorotibial angle were factors that promoted the progression of osteoarthritis in the knee joint, the correlation between the osteophyte length and each of these factors was investigated. A significant difference in osteophyte length, and in the annual increase in osteophyte length, was found between Group A and Group B, but no difference between them with regard to osteophyte location. A significant correlation was found between the osteophyte formation and each of the above-mentioned factors. The correlation was strongest with the femorotibial angle followed by age, arteriolosclerosis and obesity, in that order.

Adult↗

PubMed1996

The relation between cartilage damage and osteophyte size in a murine model for osteoarthritis in the knee.

The aim of this study was to investigate the relationship between location and size of osteophytes and cartilage loss in an instability-induced experimental model for osteoarthritis. Osteoarthritis was induced in murine knee joints by injection of highly purified bacterial collagenase, causing joint instability. The size of the osteophytes and the cartilage loss were measured at different locations in the joint using image analysis on histological sections of total kees. Cartilage damage did not occur without osteophytes. Osteophytes were located on both medial and lateral sides, independent of the location of cartilage damage, but the size of the osteophytes was related to the amount of cartilage damage on the corresponding side. Cartilage loss on the lateral tibial plateau correlated well with the size of lateral osteophytes, in particular with the osteophyte at the margin of the lateral tibial plateau. Cartilage loss on the medial tibial plateau appeared to have a good correlation with the size of medial osteophytes, which was most pronounced for the osteophyte on the medial margin of the tibial plateau. This side-specific correlation between cartilage damage and osteophyte formation suggests compartmentalization of the osteoarthritic process.

Animals↗

PubMed2006

Expression of transforming growth factor-beta (TGFbeta) and the TGFbeta signalling molecule SMAD-2P in spontaneous and instability-induced osteoarthritis: role in cartilage degradation, chondrogenesis and osteophyte formation.

BACKGROUND: The primary feature of osteoarthritis is cartilage loss. In addition, osteophytes can frequently be observed. Transforming growth factor-beta (TGFbeta) has been suggested to be associated with protection against cartilage damage and new cartilage formation as seen in osteophytes. OBJECTIVE: To study TGFbeta and TGFbeta signalling in experimental osteoarthritis to gain insight into the role of TGFbeta in cartilage degradation and osteophyte formation during osteoarthritis progression. METHODS: Histological sections of murine knee joints were stained immunohistochemically for TGFbeta3 and phosphorylated SMAD-2 (SMAD-2P). Expression patterns were studied in two murine osteoarthritis models, representing spontaneous (STR/ort model) and instability-associated osteoarthritis (collagenase-induced instability model). RESULTS: TGFbeta3 and SMAD-2P staining was increasingly reduced in cartilage during osteoarthritis progression in both models. Severely damaged cartilage was negative for TGFbeta3. In contrast, bone morphogenetic protein-2 (BMP-2) expression was increased. In chondrocyte clusters, preceding osteophyte formation, TGFbeta3 and SMAD-2P were strongly expressed. In early osteophytes, TGFbeta3 was found in the outer fibrous layer, in the peripheral chondroblasts and in the core. Late osteophytes expressed TGFbeta3 only in the fibrous layer. SMAD-2P was found throughout the osteophyte at all stages. In the late-stage osteophytes, BMP-2 was strongly expressed. CONCLUSION: Data show that lack of TGFbeta3 is associated with cartilage damage, suggesting loss of the protective effect of TGFbeta3 during osteoarthritis progression. Additionally, our results indicate that TGFbeta3 is involved in early osteophyte development, whereas BMP might be involved in late osteophyte development.

Animals↗

PubMed2000

Growth factor expression in the osteophytes of the human femoral head in osteoarthritis.

Osteoarthritis is characterized by marked osteophyte formation consisting of new cartilage and bone. Because several growth factors are known to be involved in chondrogenesis and osteogenesis, the expression of transforming growth factor-beta 1 and basic fibroblast growth factor in the osteophytes of the human femoral heads in osteoarthritis were examined. Transforming growth factor-beta 1 messenger ribonucleic acid was detected in the osteophytes by reverse transcription-polymerase chain reaction. All of the nine examined osteophytes expressed transforming growth factor-beta 1 messenger ribonucleic acid, whereas one of four osteoarthritic femoral heads and none of four osteonecrotic femoral heads expressed transforming growth factor-beta 1 messenger ribonucleic acid. The extent of transforming growth factor-beta 1 messenger ribonucleic acid expression varied among the osteophytes. Transforming growth factor-beta 1 or basic fibroblast growth factor was analyzed in osteophytes immunohistochemically. Transforming growth factor-beta 1 was localized in the superficial cells in the osteophyte cartilage, but it was scarcely detected in the superficial cells in the degenerative articular cartilage. Basic fibroblast growth factor was detected in the cells in the whole layer of osteophyte cartilage and in the articular cartilage. There was a difference in the localization, which suggests the different roles of transforming growth factor-beta 1 and basic fibroblast growth factor in bone and cartilage metabolism in osteophyte formation.

Fibroblast Growth Factor 2↗

PubMed1998

Morphologic study of lumbar vertebral osteophytes.

BACKGROUND: Vertebral osteophytes are one of the principal radiographic diagnostic criteria for degenerative change in the lumbar spine. These osteophytes have been previously classified by morphologic features into two groups, the "traction spur" and the "claw spur." It has been stated that the traction spur is a sign of spinal instability. METHODS: Lumbar spines from 20 cadavers provided 120 vertebrae from T-11 to L-5 and 240 vertebral rims for study. The presence of osteophytes was determined by measurement with digital calipers. The type of osteophyte was then determined visually, using the Macnab classification. RESULTS: Sixty vertebral rims were found to have significant osteophytes. Twenty-four vertebral rims had osteophytes of the claw type only, and 11 had osteophytes of the traction type only. Of the eight vertebrae with traction osteophytes alone and with the adjacent vertebra available for study, none had such a corresponding osteophyte. CONCLUSION: Traction spurs and claw spurs frequently coexist on the same vertebral rim. This suggests that they may result from the same degenerative process and do not necessarily reflect the results of two distinct pathologic processes.

Humans↗

PubMed2001

The effect of anterior osteophytes and flexural position on thoracic trabecular strain.

STUDY DESIGN: Compressive and shear trabecular strains were evaluated using six cadaveric thoracic spines that included anterior osteophytes. The treatments were divided into three groups: 1) osteophytes intact and the specimen in the neutral position, 2) osteophytes removed and the specimen in the neutral position, and 3) osteophytes removed and the specimen with 5 degrees of additional flexion. OBJECTIVES: To investigate the influence of osteophytes and flexural position on vertebral trabecular strain during axial compression. SUMMARY OF BACKGROUND DATA: In the thoracic spine, the incidence of anterior wedge fractures increases with the severity of kyphosis. It is unclear whether the role of anterior osteophytes in the thoracic spine is to restrict progressive kyphosis, conduct axial load anteriorly, or both. METHODS: Thoracic motion segments, T10-T12, were axially loaded in compression, and the minimum principal and maximum shear strains were measured using texture correlation. RESULTS: No dramatic changes were found in the spatial distribution of the strains following removal of the anterior osteophytes. Conversely, after removal of the osteophytes and orienting the specimen in 5 degrees of additional flexion, the strain distribution shifted anteriorly and the magnitude increased. CONCLUSIONS: This study demonstrated that osteophytes seem to restrict progressive kyphosis rather than conduct axial load anteriorly.

Aged↗

PubMed2002

Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine: anatomic study and a report of four cases.

STUDY DESIGN: An anatomic study of the associations between the fifth lumbar spinal nerve (L5 spinal nerve) and a lumbosacral tunnel, consisting of the fifth lumbar vertebral body (L5 vertebral body), the lumbosacral ligament, and sacral ala, and clinical case reports of four patients with lumbar radiculopathy secondary to entrapment of the L5 spinal nerve in the lumbosacral tunnel. OBJECTIVES: To delineate the anatomic, clinical, and radiologic features and surgical outcome of patients with entrapment of the L5 spinal nerve in the lumbosacral tunnel. SUMMARY OF BACKGROUND DATA: Although several cadaveric studies on a lumbosacral tunnel as a possible cause of L5 radiculopathy have been reported, few studies had focused on osteophytes of the L5-S1 vertebral bodies as the major component of this compressive lesion, and clinical reports on patients with this disease have been rare. METHODS: Lumbosacral spines from 29 geriatric cadavers were examined with special attention to the associations between osteophytes of the L5-S1 vertebral bodies and the L5 spinal nerve. Four patients with a diagnosis of the entrapment of the L5 spinal nerve by osteophytes at the lumbosacral tunnel were treated surgically, and their clinical manifestations and surgical results were reviewed retrospectively. RESULTS: The anatomic study demonstrated osteophytes of the L5-S1 vertebral bodies in seven of the 29 cadavers. Entrapment of the L5 spinal nerve in the lumbosacral tunnel was observed in six of the seven cadavers with L5-S1 osteophytes but in only one of the 22 cadavers without such osteophytes (P < 0.05, chi2 test). All four patients had neurologic deficits in the L5 nerve root distribution. MRI and myelography showed no abnormal findings in the spinal canal, but CAT scans demonstrated prominent osteophytes on the lateral margins of L5-S1 vertebral bodies in all four. Selective L5 nerve block completely relieved all patients of pain but only temporarily. Three patients were treated via a posterior approach by resecting the sacral ala along the L5 spinal nerve, and the other patient was treated by laparoscopic anterior resection of the osteophytes. Pain relief was obtained in the four patients immediately after surgery, but one patient experienced recurrence of pain 1 year after the first surgery and was successfully treated by additional posterior decompression and fusion. CONCLUSIONS: Extraforaminal entrapment of L5 spinal nerve in the lumbosacral tunnel can cause L5 radiculopathy, and osteophytes of L5-S1 vertebral bodies are a major cause of the entrapment.

Aged↗

PubMed2000

Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration.

OBJECTIVE: This study evaluated the clinical significance of cervical osteophytes impinging on the pharynx in patients with dysphagia and the importance of concurrent disorders that may affect swallowing function. MATERIALS AND METHODS: On videofluoroscopy, anterior cervical osteophytes were found in 55 (32 men, 23 women; mean age, 69 years) of 3318 patients with dysphagia (1.7%). Coexisting diseases that affected swallowing function were found in 28 patients (stroke, n = 7; thyroidectomy, n = 7; tongue base or laryngeal cancer surgery, n = 5; other diseases, n = 9). Swallowing function was assessed with videofluoroscopy evaluating epiglottic tilting, laryngeal closure, impression of the hypopharynx, pharyngeal residue, and aspiration. RESULTS: With advancing age, the probability of aspiration (odds ratio, 1.07; p < 0.05) and of enlarging osteophytes (odds ratio, 1.26; p < 0.01) increased; the probability was higher for osteophytes at more than one vertebrae (odds ratio, 8.00; p < 0.01) and for concurrent diseases (odds ratio, 8.02; p < 0.01). Aspiration was found in 75% of patients with osteophytes larger than 10 mm and in 34% with osteophytes smaller than or equal to 10 mm. In 88% of patients with small osteophytes who aspirated, other diseases affected swallowing function. CONCLUSION: Aspiration is common in patients with dysphagia and cervical osteophytes larger than 10 mm. Aspiration is rare in patients with osteophytes smaller than or equal to 10 mm unless these patients suffer from other disorders that may affect swallowing.

Cervical Vertebrae↗

PubMedDate not supplied

Management of respiratory compromise caused by cervical osteophytes: a case report and review of the literature.

BACKGROUND CONTEXT: Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH is associated with large anterior osteophytes of the cervical spine, which can cause complications by compressing adjoining structures. Dysphagia is reported in up to 28% of patients, but respiratory compromise is rare. There have been no published recommendations for treatment. PURPOSE: To report that resection of cervical osteophytes, without cervical fusion, can be successful in the treatment of severe respiratory distress. STUDY DESIGN: This report describes the management of a patient with DISH and severe respiratory distress resulting from large anterior cervical osteophytes. METHODS: A team approach was used with collaboration between the orthopedic spine surgeons and the otolaryngologists. RESULTS: This patient was found to have compression of her posterior pharyngeal wall by the osteophytes. Tracheostomy was required for the management of the airway. The patient was dependent on the tracheostomy until the osteophytes were resected. The patient was then able to breathe normally. Treatment recommendations were developed based on this case of osteophyte-induced respiratory compromise as well as the previously published accounts of osteophyte-induced dysphagia. CONCLUSIONS: Airway obstruction resulting from DISH can be treated according to the same principles as dysphagia resulting from DISH: surgical excision of osteophytes if conservative support fails.

Airway Obstruction↗