Often under-reported and only occasionally problematic, osteophytes still warrant some serious conversation. When larger in size and at certain levels of the spine, osteophytes can cause a person a lot of trouble with their swallowing! When identified and managed by a cohesive multidisciplinary team including an experienced surgeon and speech pathologist, the outcomes can in fact be fantastic! Read on for one such story…
To set the scene, what is an osteophyte? These are findings on x-rays that are seen mostly in the elderly population. They can be caused by spinal degeneration, previous trauma, previous surgery, or different conditions such as diffuse idiopathic skeletal hyperostosis (DISH). You can think of them as little bony outcroppings from the spine pushing toward the throat. Studies have shown that less than 1% of cervical (neck) osteophytes lead to swallowing problems (dysphagia) and only 1.7% of cases of dysphagia have been documented to be caused by these osteophytes. That said, when they are large enough and in the right position, they can cause significant interference for a person’s swallowing. At the minor end of the scale, osteophytes can cause an occasional feeling of some solid foods feeling briefly held up in the throat when swallowing. In more severe cases, patients can have drinks they are swallowing redirected from the throat into the airway causing aspiration, or fluid going onto the lungs. When this occurs, it can be very problematic because patients can start to develop recurrent chest infections, lose weight, significantly alter their oral diet, stop socialising over meals and more. All need not be lost here though. Things can be done to sort these problems out!
Take Ralph* for example, he attended my practice, Eastern Suburbs Speech Pathology, with a referral from his GP and a lot of encouragement from his wife. He had a 10-year history of deteriorating swallowing. He complained that a number of different foods would stick in his throat and he was having increasing episodes of coughing with both eating and drinking. He was losing weight. A swallowing assessment in my rooms identified features of dysphagia and as a result, I recommended he go ahead with a video fluoroscopic swallow study (VFSS). This is essentially an x-ray of the swallow. Video images are taken whilst the patient is swallowing various foods and fluids. The speech pathologist is present, along with a radiologist and radiographer, to look at both the anatomy and physiology or movement of the swallow. Ralph’s VFSS identified large osteophytes from the level C3 down to C6. In other words, his osteophytes were big and impressive. They were causing solids to stick in the throat during and after swallows and fluids were being aspirated. My suggestion at that time was to alter the texture of his foods and fluids to reduce the risk of aspiration in the short term. I also suggested he see Associate Professor Richard Gallagher, experienced head and neck surgeon who works with osteophytes, to seek his wise counsel on what management options could be available to him. Ralph’s multidisciplinary team was growing!
Richard conducted a thorough assessment in his rooms which included history taking, review of imaging, and a nasendoscopic assessment of his throat. Given the size and extent of Ralph’s osteophytes, as well as the obvious functional problems he was having, the decision was made by Ralph to proceed with surgery. His surgery involved accessing his spine via the neck and the removal of the osteophytes or bony outcroppings from the spine by Richard. Ralph had a stay at St Vincent’s Private Hospital to recover from the surgery and to receive acute dysphagia therapy. His stay included a short period of feeding via a tube in his nose whilst we waited for his acute swelling to go down. Richard and I saw him together in his rooms at intervals during the stay to conduct progress assessments, he had daily therapy on the ward from my speech pathology team, and also underwent progress VFSS. His dysphagia therapy continued upon discharge home and his oral diet progressed.
Fast forward three and a half months and Ralph, who had struggled with worsening swallowing problems and weight loss for 10 years, had gained a healthy 8 kg, was feeling well, and so importantly, was back to enjoying normal drinks and foods! It is a great joy to see Ralph and his wife at their local café, me, smiling when catching a happy glimpse of him sipping a coffee with friends.
The takeaway, if osteophytes are identified and are having a functional impact on a person’s swallow there is excellent indication to work with dysphagia experts such as Richard and I. This can ensure that symptoms are addressed and the impact of the osteophytes can be minimized or, like in Ralph’s case, gone altogether! If you are concerned about your swallowing, please reach out to Eastern Suburbs Speech Pathology and The ENT for assessment and care.
Therese Dodds
Director – Eastern Suburbs Speech Pathology
Director – Speech Pathology St Vincent’s Private Hospital Sydney
*Alias for privacy reasons
