Cervical Osteophytosis Causing Tracheomalacia and Dyspnea

Cervical osteophytosis, a common manifestation of degenerative spondylosis, can rarely exert mass effect to compromise adjacent airway structures. Acquired tracheomalacia secondary to anterior cervical osteophytes is exceptionally uncommon and results from dynamic airway collapse due to weakened tracheal cartilaginous support. Tracheomalacia may present with nonspecific respiratory symptoms such as dyspnea, cough, and orthopnea, and diagnosis is best established with direct visualization on bronchoscopy. We report a rare case of localized upper tracheal tracheomalacia caused by cervical diffuse idiopathic skeletal hyperostosis (DISH) with severe anterior osteophyte formation, resulting in clinically significant airway obstruction. A 74-year-old male with a history of coal worker's pneumoconiosis, osteoarthritis, DISH, and prior lumbar spine surgery presented with a six-year history of progressive dyspnea, recently complicated by audible resting stridor. He denied dysphagia or orthopnea. Bronchoscopy demonstrated dynamic upper tracheal collapse consistent with localized tracheomalacia. MRI and X-ray imaging revealed extensive anterior cervical osteophytes from C5-C7 producing marked posterior compression of the trachea and esophagus, accompanied by cervical spinal stenosis extending from C1-C6. Given progressive airway compromise, the patient underwent anterior cervical microsurgical osteophyte excision with posterior decompressive laminectomy and foraminotomies. Resection was confirmed intraoperatively with microscopy and fluoroscopy. Postoperatively, the patient exhibited resolution of stridor, improved respiratory function, and no new neurological deficits, and he remained symptom-free at follow-up. This case highlights a rare but clinically significant cause of acquired tracheomalacia due to compressive cervical osteophytosis associated with DISH. Progressive dyspnea and stridor in patients with extensive anterior cervical osteophytes should prompt thorough airway evaluation, including bronchoscopy and cross-sectional imaging. Surgical decompression can provide durable symptomatic relief and restoration of airway patency in appropriately selected patients.