Dysphagia and Dyspnoea as Complications in Spondylarthritis Ankylopoetica with Cervical Osteophytes

Treated in 1936 at another'hospital for an attack of rheumatoid arthritis which subsided without resultant symptoms.He was treated a t the Orthopaedic Clinic i n Lund i n December 1966, when extirpation of cartilaginous bone formation, caused by osteochondromatosis in the right hip joint, was performed.He was slightly confused for two or three days postoperatively.He returned in April 1967 for a McMurray osteotomy.This was performed with intubation under general anaesthesia.No complications associated with the intubation were recorded.The postoperative course was at first uneventful, but on the fifth day, he exhibited mental symptoms of an hallucinatory nature, similar to those seen after the aforementioned operation.The symptoms remained, but were mild.Three weeks postoperatively his temperature increased, accompanied by a cough and copioiis amount of phlegm in the air passages.X-ray showed no positive parenchymal change.For the first time, he mentioned discomfort in the back of his neck.He occasionally had the feeling of a lump in his throat and difficulty in swallowing, mainly solid food.Both solids and liquids often entered the wrong passage.The patient also said that a few months previously he had had some difficulties in breathing and had a constricting feeling in his throat, which increased when lying down.Because of this, he was constantly compelled to clear his throat.For the first time the cervical spine was X-rayed.Ankylosing spondylitis with osteophytes was diagnosed.Level with the disc between 3rd and 4th cervical vertebrae, one of these osteophytes was shown as a pronounced forward-directed projection, protruding almost 2 cm (Figure 1).X-ray of trachea and larynx showed that this osteophytic projection of the cervical vertebra was level with the epiglottis, where it caused a constriction (Figure 2).The patient's general condition deteriorated postoperatively in the fourth week.He had increased amounts of sputum, became confused, had difficulty in breathing, and showed signs of considerable respiratory ohstruction with marked respiratory stenosis heard over the trachea.