Rapidly Progressing Dysphagia After Thoracic Spinal Cord Injury in a Patient With Ankylosing Spondylitis: A Case Report

Geriatric Orthopaedic Surgery & Rehabilitation, 2023 · DOI: 10.1177/21514593231159353 · Published: January 1, 2023

Simple Explanation

This case report describes a 79-year-old man with ankylosing spondylitis (AS) who experienced rapidly progressing dysphagia (difficulty swallowing) after a thoracic spinal cord injury (SCI). The patient had pre-existing anterior cervical osteophytes (bone spurs in the neck) but no dysphagia prior to the SCI. After the SCI, the patient developed aspiration pneumonia, and a videofluoroscopic swallowing study revealed problems with epiglottic closure due to syndesmophytes (bony growths) at the C2-C3 and C3-C4 levels in his cervical spine. Despite treatment, his condition worsened, and he eventually died from complications. The authors suggest that the rapid exacerbation of dysphagia was likely due to a combination of factors, including general deterioration from the SCI, sarcopenic dysphagia (loss of muscle mass affecting swallowing), and compression from the cervical osteophytes. They emphasize the importance of early dysphagia screening in bedridden patients with AS or SCI.

Study Duration

Not specified

Participants

A 79-year-old man

Evidence Level

Level 4; Case Report

Key Findings

1
A patient with ankylosing spondylitis and pre-existing cervical osteophytes developed rapidly progressing dysphagia after a thoracic spinal cord injury.
2
Videofluoroscopic swallowing studies revealed epiglottic closing problems due to syndesmophytes at the C2-C3 and C3-C4 levels.
3
General deterioration, sarcopenic dysphagia, and compression from cervical osteophytes likely contributed to the rapid exacerbation of dysphagia.

Research Summary

This case report describes a 79-year-old male with ankylosing spondylitis (AS) who developed rapidly progressing dysphagia following a thoracic spinal cord injury (SCI). The patient had pre-existing cervical osteophytes but no prior history of swallowing difficulties. Following the SCI, the patient experienced aspiration pneumonia, and a videoﬂuoroscopic swallowing study (VFSS) indicated dysphagia related to epiglottic closing problems caused by cervical syndesmophytes. Despite treatment, the patient's condition declined, ultimately leading to death from atelectasis and sepsis. The authors suggest that the rapid progression of dysphagia was likely multifactorial, involving general physical decline from the SCI, sarcopenic dysphagia, and the compressive effects of the existing cervical osteophytes. They highlight the need for early dysphagia screening in bedridden patients with AS or SCI.

Practical Implications

Early Dysphagia Screening

Implement early and regular dysphagia screening for bedridden patients with AS or SCI, especially those with pre-existing cervical osteophytes.

Comprehensive Assessment

Perform thorough assessments to identify potential contributing factors to dysphagia, including sarcopenia, neurological deficits, and structural abnormalities.

Multidisciplinary Approach

Utilize a multidisciplinary team approach, including rehabilitation specialists, speech therapists, and physicians, to manage and treat dysphagia effectively.

Study Limitations

1
The exact cause of dysphagia could not be definitively identified due to the inability to perform diagnostic tests for sarcopenic dysphagia.
2
The study is limited by being a single case report, which limits the generalizability of the findings.
3
Lack of specific measurements (handgrip strength, gait speed, swallowing muscle strength) hinders a definitive diagnosis of sarcopenic dysphagia.

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