Cervical spine involvement in ankylosing spondylitis mimicking Eagle’s syndrome

A 42-year-old man presented with 4 years’ history of low back pain. The pain was inflammatory in nature with early morning stiffness of more than one h. At presentation, he reported difficulty in swallowing with throat pain and sensation of a foreign body for the previous 6 months. He had no constitutional symptoms. The patient’s personal and family past medical history was unremarkable. He had partial response to non-steroidal inflammatory drugs. On examination, cervical motion was limited in all directions. Cervical spine ossification was observed on cervical imaging (Fig. 1A). Thoracolumbar and pelvic radiography was normal. MRI revealed findings of bone oedema at the bilateral sacral and iliac wings (Fig. 1B). The laboratory investigation showed an ESR of 25 mm/h, CRP of 22 mg/l and HLA-B27 was positive. The diagnosis of dysphagia due to cervical ossification of ankylosing spondylitis (AS) was established, and certolizumab and swallowing rehabilitation therapy was started for the patient. Significant clinical improvement was observed on inflammatory pain and dysphagia within six months. Symptoms of Eagle’s syndrome include dysphagia, sensation of a foreign body and throat pain, and may be evaluated for cervical spine ossification [1]. Dysphagia has rarely been associated with AS. Early diagnosis and treatment of AS is key to preventing complications [2].

Fig. 1

Cervical spine and sacroiliac joint involvement in ankylosing spondylitis

(A) Lateral cervical spine radiograph showing exuberant ossification developed from the anterior corners of C5–C6 and C6–C7. (B) MRI showing of bone oedema at the bilateral sacral and iliac wings.

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Funding: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.

Disclosure statement: The authors have declared no conflicts of interest.

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