OSSIFICATION OF THE ANTERIOR LONGITUDINAL LIGAMENT AND FORESTIER-DISEASE - AN ANALYSIS OF 7 CASES

A retrospective review was conducted on the records and radiographs of six symptomatic patients and one asymptomatic patient with Forestier' s disease. No other series of patients with this disease is found in t he neurosurgical literature. Forestier's disease, also known as diffus e idiopathic skeletal hyperostosis (DISH), is an idiopathic rheumatolo gical abnormality in which exuberant ossification occurs along ligamen ts throughout the body, but most notably the anterior longitudinal lig ament of the spine. It affects older men predominantly; all of our pat ients were men older than 60 years of age. The disease is usually asym ptomatic; however, dyspnea, dysphagia, spinal cord compression, and pe ripheral nerve entrapment have all been documented in association with the disorder. Five of the six symptomatic patients presented with dys phagia due to esophageal compression by calcified anterior longitudina l ligaments, acid one patient developed recurrent spinal stenosis when scar tissue from a previous decompressive laminectomy became calcifie d. Ah patients responded well to surgery. Two of the four patients who underwent removal of cervical osteophytes required several months fol lowing surgery for the dysphagia to resolve. This would support the hy pothesis that not all cases of dysphagia in Forestier's disease are du e to mechanical compression. Dysphagia may result from inflammatory ch anges that accompany fibrosis in the wall of the esophagus or from eso phageal denervation. Evaluation of dysphagia even in the presence of F orestier's disease must rule out occult malignancy. The authors' exper ience suggests that dysphagia in the setting of Forestier's disease is an underrecognized entity amenable to surgical intervention.