1126 - Swallow Recovery Following Cervical Osteophytectomy in Spinal Cord Injury: A Case of DISH-phagia

Dysphagia Following Cervical Spinal Cord Injury

Case Description:

A 77-year-old male sustained an unwitnessed fall resulting in an acute Diffuse Idiopathic Skeletal Hyperostosis (DISH) fracture at C5–C6, extending through the C6 vertebral body, with widening of the right C5–C6 facet joint and a comminuted C5 spinous process fracture involving the left lamina. He underwent C4–C7 laminectomy with C2–T2 posterior instrumented fusion. Postoperatively, his course was complicated by severe pharyngeal dysphagia due to a protruding osteophyte, necessitating percutaneous endoscopic gastrostomy (PEG) placement. Two months later, he underwent anterior C4–C7 osteophytectomy with C6 corpectomy and plating. On admission to the inpatient rehabilitation program, modified barium swallow (MBS) showed moderate oropharyngeal dysphagia, and he remained NPO with PEG feeding. Over the course of rehabilitation, with speech-language pathology (SLP) intervention, he progressed to a dysphagia level 7 diet with thin liquids, successfully weaning from enteral nutrition prior to discharge.

Discussions:

Cervical spinal cord injuries significantly increase the risk of impaired swallowing, which may be exacerbated by compressive cervical osteophytes. The development of osteophytes is often an underappreciated complication following anterior cervical discectomy and fusion (ACDF) and presents particular concern with traumatic disruptions. In this case, adjunctive therapies including expiratory muscle strength training (EMST) and surface electromyography (sEMG) biofeedback, in addition to standard aspiration precautions coupled with structured compensatory strategies and exercises, facilitated safe swallow function and meaningful dietary progression during inpatient rehabilitation. Additionally, this case reveals the potential for swallow recovery in cervical spinal cord injury with subsequent osteophytectomy occurring months from time of initial injury.

Conclusions:

Swallow recovery following cervical osteophytectomy in the context of spinal cord injury necessitates multidisciplinary care with intensive SLP. For patients with moderate to severe oropharyngeal dysphagia, utilizing EMST and sEMG as part of ongoing rehabilitation have the potential for dietary advancement, liberalization from enteral nutrition, and improved quality of life.