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

Abstract

Introduction: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease affecting the axial skeleton, including the sacroiliac joint, which causes vertebral fusion in the advanced stage. However, reports of anterior cervical osteophytes compressing the esophagus and causing dysphagia in patients with AS are rare. Here, we present the case of a patient with AS and anterior cervical osteophytes who exhibited rapidly progressing dysphagia after thoracic spinal cord injury (SCI).

Case presentation: The patient, a 79-year-old man, was previously diagnosed with AS and had syndesmophytes at C2-C7 without dysphagia for several years. In 2020, he began to experience paraplegia, hypesthesia, and bladder and bowel dysfunction after a fall. He also had T9 SCI American Spinal Injury Association Impairment Scale grade A due to a T10 transverse fracture. Four months after SCI, he developed aspiration pneumonia, and a videofluoroscopic swallowing study indicated dysphagia with epiglottic closing problems due to syndesmophytes at the C2-C3 and C3-C4 levels. He received treatment for dysphagia and VitalStim therapy thrice (once daily); however, the recurrent pneumonia and fever continued. He further underwent bedside physical therapy and functional electrical stimulation once daily. However, he died from atelectasis and exacerbation of sepsis.

Discussion and conclusion: General deterioration of the patient's physical condition due to SCI, sarcopenic dysphagia, and compression of cervical osteophytes seemed to be involved in rapid exacerbation following SCI. Early screening for dysphagia is vital in bedridden patients with AS or SCI. Additionally, assessment and follow-up are important if the number of rehabilitation treatments or the out-of-bed movement activity decreases because of pressure ulcers.