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Globus Sensation Associated with Cervical Spondylolisthesis

Mabry, Lance M. PT, DPT, OCS; Ross, Michael D. PT, DHSc; Martin, Paul A. MD; Tall, Michael A. MD; Elliott, Ryan L. PT, OCS

American Journal of Physical Medicine & Rehabilitation: July 2011 - Volume 90 - Issue 7 - p 615
doi: 10.1097/PHM.0b013e318214e269
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From the Department of Physical Therapy, Kaiser Permanente Medical Center, Vallejo, California (LMM, RLE); Department of Physical Medicine, 382d Training Group, Fort Sam Houston, San Antonio, Texas (MDR); Department of Otolaryngology Head & Neck Surgery, Kaiser Permanente Medical Center, Vallejo, California (PAM); and Department of Musculoskeletal Imaging, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas (MAT).

The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the Department of Defense, the United States Air Force, or other federal agencies.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

All correspondence and requests for reprints should be addressed to: Lance M. Mabry, PT, DPT, OCS, Kaiser Permanente Medical Center, Outpatient Physical Therapy Department, 975 Sereno Drive, Vallejo, CA 94589.

A 63-yr-old woman reported to an outpatient physical therapy clinic with a 1-yr history of right-sided neck pain that was insidious at onset. The patient's symptoms presented as an intermittent ache with numbness and tingling radiating down the right upper limb to the dorsal aspect of the hand. In the previous month, the patient had developed transient weakness of both arms affecting the right side greater than the left. Her symptoms were exacerbated by lying on her right side, right cervical rotation, overhead extension of arms, and use of a computer mouse. She also had a 1-yr history of globus sensation that was noted initially at the same time as her onset of neck pain. She described these symptoms as a "lump in her throat," hoarseness, and tightness/pressure. The globus sensation was worse when lying supine on a pillow and was intermittently associated with dysphagia.

The patient's previous medical history included hypertension, gastroesophageal reflux disease, and vertigo. Laboratory values for thyroxine and thyroid-stimulating hormone were within reference limits. Previous laryngoscopy was significant for erythema and edema of the posterior commissure and the arytenoid complex. The patient was prescribed Omeprazole, which alleviated the burning symptoms from her gastroesophageal reflux disease but did not change the globus sensation.

Cervical active range of motion was within functional limits in all planes. Strength testing, sensation, and deep tendon reflexes for the upper or lower limbs were within normal limits. Clonus, Babinski sign, and Hoffmann's reflex were not present. Gait and hand dexterity were normal. Posterior-to-anterior pressure applied to the C4 spinous process was significant for instant reproduction of the globus sensation. The latent reproduction of neck pain and right upper limb numbness was appreciated after the C4 palpation.

Cervical radiographs demonstrated multilevel spondylosis contributing to a grade I to II anterolisthesis of C4 on C5 vertebrae (Fig. 1 A). Magnetic resonance imaging also demonstrated a grade I to II anterolisthesis of C4 on C5 vertebrae, a grade I retrolisthesis of C5 on C6 vertebrae, and an associated broad disc bulging causing mild central canal narrowing (Fig. 1 B). The patient was referred to a spinal surgeon but ultimately refused surgical intervention.



Cervical induced deglutition disorders have been widely reported in the literature, stemming from both anterior vertebral osteophytosis1,2 and thickness of the anterior cervical fusion hardware.3 To our knowledge, we are not aware of any reports of globus sensation arising from a cervical spondylolisthesis. It is reasonable to assume that sagittal displacement of the cervical spine is capable of altering esophageal alignment, thus inducing a globus sensation or a deglutition disorder. Cervical pathology including anterior osteophytosis and spondylolisthesis should be considered in the differential diagnosis of patients with a globus sensation or deglutition disorders.

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