Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided lateral cervical spine X-ray, there is a notable bony spur-like proliferation and calcification in the anterior longitudinal ligament region (i.e., the anterolateral aspect of the vertebral bodies). It presents as a continuous “flowing” manifestation, involving multiple segments of the cervical vertebrae. The adjacent intervertebral spaces appear relatively preserved, with no obvious narrowing of the disc spaces or significant disc degeneration. No clear ossification of the posterior longitudinal ligament or obvious facet joint fusion is observed. Overall, the images are consistent with non-inflammatory, extensive osteophyte formation. Clinically, the patient presents with mild pharyngeal discomfort, and a hard, bony protrusion can be palpated on the posterior pharyngeal wall, corresponding to the location of the anterior vertebral osteophytes as shown on the imaging.

II. Possible Diagnoses

1. Diffuse Idiopathic Skeletal Hyperostosis (DISH, also known as Forestier’s Disease)
   Rationale: Multi-segmental calcification/ossification in the anterior longitudinal ligament resembling a “flowing” pattern, with relatively preserved intervertebral disc spaces, and mild clinical symptoms (e.g., swallowing discomfort, foreign body sensation in the throat) should first prompt consideration of this condition. There is no evident sacroiliac joint abnormality, nor significant facet joint fusion.
2. Degenerative Cervical Spondylosis (Cervical Vertebral Osteophyte Formation)
   Rationale: Cervical degeneration can lead to osteophyte formation and joint changes. However, it is often accompanied by prominent disc degeneration (e.g., disc space narrowing, localized osteophytes), which differs from the “flowing,” extensive ossification pattern seen in this case.
3. Ankylosing Spondylitis (AS)
   Rationale: This disease typically features sacroiliac joint involvement and “bamboo spine” changes along the margins of the vertebral bodies, commonly found in young males. No obvious sacroiliac joint involvement is observed in this patient, inconsistent with the typical presentation of AS.

III. Final Diagnosis

Considering this 72-year-old male patient’s age, clinical symptoms (throat discomfort, palpable hard bony prominence on the posterior pharyngeal wall), and imaging findings of multi-segmental, “flowing” osteophyte formation along the anterolateral cervical vertebrae with relative preservation of the intervertebral disc spaces, the most likely diagnosis is: Diffuse Idiopathic Skeletal Hyperostosis (DISH/Forestier’s Disease).

If there is any uncertainty, further assessment via CT 3D reconstruction or MRI can be performed to evaluate soft tissue and potential tracheoesophageal compression. Additionally, ENT or endoscopic evaluation may be warranted to clarify the extent of esophageal involvement and compression.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategies

1. Conservative Treatment: For mild symptoms, begin with non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and stiffness; combine with physical therapy such as warm compresses, ultrasound, manual therapy, and muscle strengthening exercises.
2. Surgical Treatment: If the patient develops significant dysphagia, airway compromise, or notable neurological deficits (such as severe nerve root or spinal cord compression), surgical removal of the osteophytes or decompression may be considered. However, the risks and benefits should be carefully evaluated.

2. Rehabilitation/Exercise Prescription

In cases of mild symptoms or after surgical stabilization, a gradual rehabilitation program can be initiated. Following the FITT-VP principle:

• Frequency: 3–5 times per week
• Intensity: Start with low-intensity neck exercises, such as gentle stretching and range of motion exercises. Increase intensity gradually as tolerated.
• Time: Each session can last 15–30 minutes. It can be divided into segments (e.g., 2–3 sessions per day, 10 minutes each).
• Type: Focus on stretching and strengthening exercises for the neck and shoulder muscles, for example:
  • Neck care exercises: Slow flexion, extension, lateral bending, and rotation of the neck, with moderate range of motion.
  • Appropriate shoulder exercises: Shoulder swinging, shoulder circles, and mild resistance training for the shoulder joint.
  • Whole-body endurance activities: Walking, tai chi, swimming, or other low-impact exercises.
• Progression: As symptoms improve and muscle strength increases, gradually add resistance training and increase intensity and duration under professional guidance.

Rehabilitation programs should be individualized, considering the patient’s specific condition (e.g., comorbid cardiovascular issues, osteoporosis, or other metabolic disorders) to avoid secondary injuries due to overexertion. If severe pain or discomfort occurs, exercise should be stopped immediately and medical advice sought.

V. Disclaimer

This report is a reference-based analysis relying on available imaging and history and cannot replace an in-person consultation or professional medical opinion. Specific treatment and rehabilitation plans should be determined by specialized clinical physicians based on a comprehensive evaluation of the patient’s actual condition.