Surgical treatment of Forestier disease

Abstract

Historical information, epidemiology, risk factors, diagnosis and known methods of treating diffuse idiopathic skeletal hyperostosis – Forestier disease – a rare idiopathic non-inflammatory disease of the musculoskeletal system characterized by ossification of ligaments and tendons, gradually leading to ankylosis, are presented. The differential diagnostic criteria for this disease are listed. The clinical picture of vertebral and extravertebral localization of foci of hyperostosis is described. A clinical case of severe recurrent idiopathic hyperostosis of the cervical spine, manifested by dysphonia, dysphagia and pain, is considered. The peculiarity of this case is gross hyperostosis, which is a recurrence of Forestier disease in the cervical spine 12 years after surgical treatment. The indications and the required volume of the operation, as well as the difficulties of re-surgical treatment of Forestier disease with localization of hyperostosis in the cervical spine, are listed. In general, repeated surgical treatment of Forestier disease is associated with a pronounced scar-adhesive process, which increases the duration of the operation and the amount of blood loss. In case of damage to the cervical spine with severe compression of the pharynx, esophagus and respiratory tract, it is enough to perform a decompressive intervention. A stabilizing benefit is not required, due to the lack of signs of instability of the operated vertebral-motor segment both intraoperatively and in the postoperative period. At the same time, surgical treatment with this nosology is not radical and does not cure patients even at the level of surgical intervention. However, the operation is indicated for severe compression of the neck organs and neurovascular structures.

Keywords

Forestier disease / diffuse idiopathic skeletal hyperostosis / compression of neck organs / dysphagia / dysphonia / decompression / recurrence / reoperation

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RIGHTS & PERMISSIONS

Lakhin R.E., Zhirnova E.A., Grachev I.N.