Discussion

Cervical involvement in DISH represents an underrecognized structural cause of dysphagia in elderly patients, despite its reported prevalence of up to 32% in geriatric cohorts [7]. The formation of exuberant anterior osteophytes may result in esophageal compression and compromise of the upper airway, leading to clinical manifestations that include progressive dysphagia, dysphonia, and aspiration [8].

The primary mechanism of dysphagia in this setting is related to direct esophageal displacement and compression by anterior cervical osteophytes, as well as reduced cervical mobility secondary to vertebral ankylosis, which impairs the biomechanics of effective swallowing [9]. In the present case, this mechanism was identified as the main contributor to esophageal symptoms. The typically anterior and symmetric pattern of ossification explains the compression observed on imaging studies and its clinical correlation [7].

CT plays a central role in diagnosis, as it allows precise assessment of the extent of ossification and its anatomical relationship with the esophagus and trachea, thereby facilitating the differential diagnosis from other structural causes of dysphagia [8,10]. In our case, correlation between clinical findings and CT and MRI was essential to establish the diagnosis according to the Resnick and Niwayama criteria while excluding other causes of dysphagia, including axial spondyloarthritis, degenerative cervical disease, and neoplasia [6].

Although initial management is usually conservative, surgical osteophytectomy may be considered in patients with significant dysphagia or respiratory compromise. Previous case series have reported symptomatic improvement in most patients following surgery [1].

This case underscores the importance of considering cervical DISH in the differential diagnosis of progressive dysphagia in older adults and highlights the value of clinicoradiological correlation to ensure appropriate management and prevent potentially serious complications.