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Nakajima H, Watanabe S, Honjoh K, Kubota A, Matsumine A. Risk factors for early-onset adjacent segment degeneration after one-segment posterior lumbar interbody fusion. Sci Rep 2024; 14:9145. [PMID: 38644389 PMCID: PMC11033273 DOI: 10.1038/s41598-024-59924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Adjacent segment degeneration (ASD) is a major postoperative complication associated with posterior lumbar interbody fusion (PLIF). Early-onset ASD may differ pathologically from late-onset ASD. The aim of this study was to identify risk factors for early-onset ASD at the cranial segment occurring within 2 years after surgery. A retrospective study was performed for 170 patients with L4 degenerative spondylolisthesis who underwent one-segment PLIF. Of these patients, 20.6% had early-onset ASD at L3-4. In multivariate logistic regression analysis, preoperative larger % slip, vertebral bone marrow edema at the cranial segment on preoperative MRI (odds ratio 16.8), and surgical disc space distraction (cut-off 4.0 mm) were significant independent risk factors for early-onset ASD. Patients with preoperative imaging findings of bone marrow edema at the cranial segment had a 57.1% rate of early-onset ASD. A vacuum phenomenon and/or concomitant decompression at the cranial segment, the degree of surgical reduction of slippage, and lumbosacral spinal alignment were not risk factors for early-onset ASD. The need for fusion surgery requires careful consideration if vertebral bone marrow edema at the cranial segment adjacent to the fusion segment is detected on preoperative MRI, due to the negative impact of this edema on the incidence of early-onset ASD.
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Affiliation(s)
- Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Shuji Watanabe
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuya Honjoh
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Arisa Kubota
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Akihiko Matsumine
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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Chen H, Zhu X, Zhou Q, Pu X, Wang B, Lin H, Zhu Z, Qiu Y, Sun X. Utility of MRI-based vertebral bone quality scores and CT-based Hounsfield unit values in vertebral bone mineral density assessment for patients with diffuse idiopathic skeletal hyperostosis. Osteoporos Int 2024; 35:705-715. [PMID: 38148381 DOI: 10.1007/s00198-023-06999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
This study investigated bone mineral density assessment for patients with DISH. DXA-based T-scores overestimated bone quality, while MRI-based VBQ scores and CT-based HU values provided accurate assessments, particularly for advanced degenerative cases. This enhances accurate evaluation of BMD, crucial for clinical decision-making. PURPOSE To investigate the diagnostic effectiveness of DXA, MRI, and CT in assessing bone mineral density (BMD) for diffuse idiopathic skeletal hyperostosis (DISH) patients. METHODS Retrospective analysis of 105 DISH patients and 116 age-matched controls with lumbar spinal stenosis was conducted. BMD was evaluated using DXA-based T-scores, MRI-based vertebral bone quality (VBQ) scores, and CT-based Hounsfield unit (HU) values. Patients were categorized into three BMD subgroups. Lumbar osteophyte categories were determined by Mata score. Demographics, clinical data, T-scores, VBQ scores, and HU values were collected. Receiver operating characteristic (ROC) analysis identified VBQ and HU thresholds for diagnosing normal BMD using DXA in controls. Correlations between VBQ, HU, and lumbar T-score were analyzed. RESULTS Age, gender, and BMI showed no significant differences between DISH and control groups. DISH patients had higher T-score (L1-4), the lowest T-score, and Mata scores. VBQ and HU did not significantly differ between groups. In controls, VBQ and HU effectively diagnosed normal BMD (AUC = 0.857 and 0.910, respectively) with cutoffs of 3.0 for VBQ and 104.3 for HU. DISH had higher normal BMD prevalence using T-scores (69.5% vs. 58.6%, P < 0.05), but no significant differences using VBQ (57.1% vs. 56.2%, P > 0.05) and HU (58.1% vs. 57.8%, P > 0.05). Correlations revealed moderate correlations between HU and T-scores (L1-4) in DISH (r = 0.642, P < 0.001) and strong in controls (r = 0.846, P < 0.001). Moderate negative correlations were observed between VBQ and T-scores (L1-4) in DISH (r = - 0.450, P < 0.001) and strong in controls (r = - 0.813, P < 0.001). CONCLUSION DXA-based T-scores may overestimate BMD in DISH. VBQ scores and HU values could effectively complement BMD assessment, particularly in DISH patients or those with advanced lumbar degeneration.
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Affiliation(s)
- Haojie Chen
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiufen Zhu
- Department of Orthopedic Surgery, Osteoporosis and Metabolic Bone Disease Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Xiaojiang Pu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hua Lin
- Department of Orthopedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Sun Q, Wang L, Chen X, Zhang Y, Tian Y, Yuan S, Liu X. How Sagittal Spinal Parameters Predict Anterolateral Spinal Ossification Severity: A Study Based on CT Classification. Spine (Phila Pa 1976) 2023; 48:1679-1687. [PMID: 36728011 DOI: 10.1097/brs.0000000000004582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The purpose of this study was to establish a CT classification system of anterolateral spinal ossification and analyze the effects of sagittal spinal parameters on ossification. SUMMARY OF BACKGROUND DATA Patients with diffuse idiopathic skeletal hyperostosis often present with anterolateral ossification of the spine. Few reports consider anterolateral spinal ossification at each spinal level or explore the influence of sagittal alignment. MATERIALS AND METHOD One hundred and twenty patients (79 males and 41 females) over 60 years old who underwent whole spinal CT scans from October 2018 to November 2021 were analyzed. Volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each intervertebral space, and a classification system was established. Sagittal parameters, such as thoracic kyphosis, lumbar lordosis (LL), cervical lordosis, sacral slope, and thoracolumbar junction angle of the patients were measured. Multifactor stepwise linear regression analysis and ordered logistic regression analysis were used to study the effects of the sagittal parameters on ossification grades. RESULTS The median age of the study population was 67 years (63-72 IQR). The new classification system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer intraclass correlation coefficient value of 0.909 and inter-observer intraclass correlation coefficient value of 0.900. Multivariate stepwise linear regression analysis showed that age (OR=1.30, P <0.001), weight (OR=1.23, P =0.013), and cervical lordosis (OR=1.19, P <0.001) were significantly correlated with total ossification grade. Multifactor ordered logistic regression analysis showed that there was a statistically significant correlation between cervical lordosis and the ossification grades of each intervertebral space of T1~T4 ( P ≤0.005), between thoracic kyphosis and each intervertebral space in T4~T12 ( P ≤0.019), and between thoracolumbar junction angle and each intervertebral space in T10~L3 ( P ≤0.025). LL was significantly and positively correlated with the ossification grades of each intervertebral space in T7~T11 ( P ≤0.041). LL and sacral slope were significantly negatively correlated with the ossification grades of each intervertebral space in L3~S1 ( P ≤0.047). CONCLUSION Our new classification scheme demonstrated good accuracy and reliability for the evaluation of the severity of anterolateral spinal ossification. The effect of sagittal parameters on anterolateral spinal ossification was position-specific. The greater the kyphosis or the smaller the lordosis of a spinal region, the more severe the degree of ossification in the corresponding region. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Qingyu Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
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Murakami Y, Morino T, Hino M, Misaki H, Kinoshita T, Takao M. Imaging Features of Early Diffuse Idiopathic Skeletal Hyperostosis (pre-DISH): Analysis of Progression of Ligament Ossification over 5 Years by Computed Tomography. Spine Surg Relat Res 2023; 7:443-449. [PMID: 37841032 PMCID: PMC10569810 DOI: 10.22603/ssrr.2022-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Some patients who have not been diagnosed with diffuse idiopathic skeletal hyperostosis (DISH) (patients in the preclinical stage of DISH [pre-DISH]) may develop DISH in the future. However, there are currently no clearly defined diagnostic criteria for pre-DISH. This study aims to define pre-DISH by analyzing the change in the ossification extent in each intervertebral space in the thoracic and lumbar spines over time using computed tomography (CT). Methods Of the patients who underwent CT of the thoracic to pelvic region at least twice from 2009 to 2018, 188 who underwent CT at an interval of 5 years to 5 years and 2 months were enrolled. The prevalence of DISH during the first and second CT scans was investigated. The pre-DISH feature was defined, and the prevalence of pre-DISH on the first CT and the change after 5 years in patients with pre-DISH was investigated. Results Of the 188 patients, 37 (19.7%) and 48 (25.5%) were diagnosed with DISH on the first and second CT scans, respectively. Pre-DISH was defined as the ossification characterized by the modified Mata score of three contiguous intervertebral spaces with a score of ≥2 points (222; 2 points, ligament ossification of half or more of the intervertebral disc height but incomplete fusion), and 52 patients were diagnosed with pre-DISH. Of the 52 patients with a score of ≥(222), 11 (21.2%) were diagnosed with DISH 5 years later. Conclusions Patients who have three contiguous intervertebral spaces with a modified Mata score of 2 or 3 points should be considered pre-DISH.
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Affiliation(s)
- Yusuke Murakami
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
| | - Tadao Morino
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
| | - Masayuki Hino
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
| | - Hiroshi Misaki
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
| | - Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
| | - Masaki Takao
- Department of Orthopedic Surgery, Ehime University School of Medicine, Tohon, Japan
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Tanaka A, Shimizu T, Kawai T, Fujibayashi S, Murata K, Matsuda S, Otsuki B. Risk of further surgery after decompression in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segments: focus on the number of residual lumbar/lumbosacral and sacroiliac mobile segments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2336-2343. [PMID: 37219710 DOI: 10.1007/s00586-023-07773-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Patients with diffuse idiopathic skeletal hyperostosis (DISH) that extends to the lumbar segments (L-DISH) have a high risk of further surgery after lumbar decompression. However, few studies have focused on the ankylosis status of the residual caudal segments, including the sacroiliac joint (SIJ). We hypothesized that patients with more ankylosed segments beside the operated level, including the SIJ, would be at a higher risk of further surgery. METHODS A total of 79 patients with L-DISH who underwent decompression surgery for lumbar stenosis at a single academic institution between 2007 and 2021 were enrolled. The baseline demographics and radiological findings by CT imaging focusing on the ankylosing condition of the residual lumbar segments and SIJ were collected. Cox proportional hazard analysis was conducted to investigate the risk factors for further surgery after lumbar decompression. RESULTS The rate of further surgery was 37.9% during an average of 48.8 months of follow-up. Cox proportional hazard analysis demonstrated that the presence of fewer than three segments of non-operated mobile caudal segments was an independent predictor for further surgery (including both the same and adjacent levels) after lumbar decompression (adjusted hazard ratio 2.53, 95%CI [1.12-5.70]). CONCLUSIONS L-DISH patients with fewer than three mobile caudal segments besides index decompression levels are at a high risk of further surgery. Ankylosis status of the residual lumbar segments and SIJ should be thoroughly evaluated using CT during preoperative planning.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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Phang SY, Barrett C, Purcell M. A radiological study of the natural history of diffuse idiopathic skeletal hyperostosis (DISH): a story of incomplete fusion. Br J Neurosurg 2023:1-10. [PMID: 37096425 DOI: 10.1080/02688697.2023.2197494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Introduction: DISH is an ankylosing disease, when fractured can be challenging to manage. A retrospective radiological study was conducted to evaluate the natural history and radiological characteristics of DISH on Computed tomography (CT).Methods: Paired CT scans with DISH that are separated at least two years apart were used to perform the following radiological measurements: Degree of disc space fusion, Osteophyte and vertebral body linear attenuation coefficients (LAC), and Osteophyte axial area size and location.Results: 164 patients were analysed with a mean duration of 4.49 years between scans. 38.14% (442/1159) of disc spaces had at least partial calcification. Most osteophytes were right sided before becoming more circumferential over time. The average fusion score was 54.17. Most of the changes in fusion occurred in the upper and lower thoracic regions. The thoracic region when compared to the lumbar region had a greater proportion of its disc spaced being fully fused. Disc level osteophyte areas were larger than Body level osteophytes. Disc osteophytes size growth rate drops over time from 10.89mm2/year in Stage 1 to 3.56mm2/year in Stage 3. Stage 3 disc spaces (-11.01HU/year) was also found to have had a reduction in their LAC over time when compared to Stage 1 disc spaces (17.04HU/year). This change in osteophyte LAC was not mirrored in the change in vertebral body LAC. We predict that the age of onset and complete thoracolumbar ankylosis of DISH to be 17.96 years and 100.59 years, respectively.Conclusion: DISH ankylosis of the spine a slow process that starts in the mid to lower thoracic region before extending cranially and caudally. After the bridging osteophyte has fully formed, remodelling of the osteophyte occurs.
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Affiliation(s)
- See Yung Phang
- Neurosurgery department, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
| | - Christopher Barrett
- Neurosurgery department, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
| | - Margaret Purcell
- National Spinal Injuries Unit, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
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Murakami Y, Morino T, Hino M, Misaki H, Imai H, Miura H. A Scoring System for Anterior Longitudinal Ligament Ossification of the Lumbar Spine in Diffuse Idiopathic Skeletal Hyperostosis: Relationship Between the Extent of Ligament Ossification and the Range of Motion. Global Spine J 2023; 13:378-383. [PMID: 33655763 PMCID: PMC9972288 DOI: 10.1177/2192568221996681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE To investigate the relationship between the extent of ligament ossification and the range of motion (ROM) of the lumbar spine and develop a new scoring system. METHODS Forty-three patients (30 men and 13 women) with lumbar spinal canal stenosis who underwent decompression from January to December 2018. Ligament ossification at L1/2 to L5/S was assessed on plain X-ray (Xp) and computed tomography (CT) using a modified Mata scoring system (0 point: no ossification, 1 point: ossification of less than half of the intervertebral disc height, 2 points: ossification of half or more of the intervertebral disc height, 3 points: complete bridging), and the intra-rater and inter-rater reliability of the scoring was assessed. The relationship of the scores with postoperative lumbar ROM was investigated. RESULT Intra-rater reliability was high (Cronbach's α was 0.74 for L5/S on Xp but 0.8 or above for other sections), as was inter-rater reliability (Cronbach's α was 0.8 or above for all the segments). ROM significantly decreased as the score increased (scores 1 to 2, and 2 to 3). A significant moderate negative correlation was found between the sum of the scores at L1/2-L5/S and the ROM at L1-S (ρ = - 0.4493, P = 0.025). CONCLUSION Our scoring system reflects lumbar mobility and is reproducible. It is effective for assessing DISH in fractures and spinal conditions, and monitoring effects on treatment outcomes and changes over time.
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Affiliation(s)
- Yusuke Murakami
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan,Yusuke Murakami, Department of Orthopedic
Surgery, Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime
791-0295, Japan.
| | - Tadao Morino
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Masayuki Hino
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Misaki
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
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Prognostic Factors and Optimal Surgical Management for Lumbar Spinal Canal Stenosis in Patients with Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2022; 11:jcm11144133. [PMID: 35887897 PMCID: PMC9323686 DOI: 10.3390/jcm11144133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
Lumbar spinal canal stenosis (LSS) and diffuse idiopathic skeletal hyperostosis (DISH) tend to develop in the elderly, resulting in an increased need for lumbar surgery. However, DISH may be a risk factor for poor clinical outcomes following lumbar decompression surgery, especially in patients with DISH extending to the lumbar segment (L-DISH). This study aimed to identify the prognostic factors of LSS with L-DISH and propose an optimal surgical management approach to improve clinical outcomes. Of 934 patients who underwent lumbar decompression surgery, 145 patients (15.5%) had L-DISH. In multivariate linear regression analysis of the JOA score improvement rate, the presence of vacuum phenomenon at affected segments (estimate: −15.14) and distance between the caudal end of L-DISH and decompressed/fused segments (estimate: 7.05) were independent prognostic factors. In logistic regression analysis of the surgical procedure with JOA improvement rate > 25% in L-DISH patients with both negative prognostic factors, the odds ratios of split laminotomy and short-segment fusion were 0.64 and 0.21, respectively, with conventional laminotomy as the reference. Therefore, to achieve better clinical outcomes in cases with decompression at the caudal end of L-DISH, decompression surgery without fusion sparing the osteoligamentous structures at midline should be considered as the standard surgery.
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Zhang B, Chen G, Chen X, Chen Z, Sun C. Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071652. [PMID: 35885556 PMCID: PMC9324076 DOI: 10.3390/diagnostics12071652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been evaluated as a potential risk factor of poor surgical outcomes for lumbar spinal stenosis, whereas the influence of DISH on neuroimaging characteristics and postoperative prognosis of patients with thoracic myelopathy has not been established. Therefore, this study aimed to shed light on this issue. Methods: A monocentric study enrolled 167 eligible patients with thoracic ossification of ligamentum flavum (TOLF), who were followed up for at least 2 years. Clinico-radiological parameters and surgical outcomes were compared between the DISH+ and DISH− groups before and after propensity matching. Subgroup analysis was conducted to compare the functional outcomes between mild DISH (M-DISH) and moderately severe DISH (MS-DISH) groups. Results: Fifty-eight patients were diagnosed as DISH, and its prevalence was 34.7%. Patients with DISH presented with older age, more males, taller stature, heavier weight, more commonly diffuse-type TOLF (p < 0.05). The DISH group showed significantly worse recovery rate (RR) at the final follow-up before and after propensity matching (p < 0.01), and slightly lower preoperative VAS, higher postoperative VAS and lower VAS reduction, despite not reaching the significant differences. Subgroup analysis demonstrated that the M-DISH group was associated with the lower mJOA score (p = 0.01) and RR at the final follow-up (p = 0.001), and tended to present higher preoperative VAS than the MS-DISH group. Conclusions: DISH has a significant predisposition to the elderly males with diffuse-type TOLF. Although the presence of M-DISH might bring about a suboptimal surgical outcome, both DISH and non-DISH patients experienced good neurological function improvements and pain relief through thoracic posterior decompression.
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Affiliation(s)
- Baoliang Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Xi Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
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Misaki H, Morino T, Hino M, Murakami Y, Imai H, Miura H. Can Diffuse Idiopathic Skeletal Hyperostosis Be Diagnosed by Plain Lumbar Spine X-Ray Findings Alone? Global Spine J 2022; 12:198-203. [PMID: 35253462 PMCID: PMC8907637 DOI: 10.1177/2192568220948038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To determine whether diffuse idiopathic skeletal hyperostosis (DISH) can be diagnosed based on anterior longitudinal ligamental ossification in the lumbar spine using plain lumbar spine X-ray images. METHODS This study included 100 patients (59 men and 41 women; mean age, 64.8 ± 13.8 years; range, 27-89 years) who underwent computed tomography (CT) of the chest to the pelvis in our hospital and plain lumbar spine radiography within 6 months before and after CT scanning. DISH was diagnosed based on the thoracolumbar spine CT findings using Resnick's diagnostic criteria. The patients were grouped according to DISH diagnosis into the DISH (+) and DISH (-) groups. On the frontal and lateral lumbar spine X-ray images, each spinal level from Th11/12 to L5/S was scored based on the Mata scoring system. The distribution of the Mata scores was compared between the 2 groups. RESULTS Forty (40%) patients were diagnosed with DISH based on the CT findings. A cutoff value ≥8 provided a sensitivity of 75% and specificity of 100% for diagnosing DISH, thus, indicating the validity of the cutoff value. In the DISH (-) group, no patient had ≥3 consecutive spinal levels with a Mata score ≥2, suggesting that DISH can be diagnosed on the basis of at least 3 consecutive spinal levels with a Mata score ≥2. CONCLUSION On lumbar spine X-ray images of the T11/12 to L5/S levels, a Mata score ≥2 for at least 3 consecutive levels or a total score ≥8 strongly indicates the presence of DISH.
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Affiliation(s)
- Hiroshi Misaki
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Tadao Morino
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan,TadaoMorino, Department of Orthopedic
Surgery, Ehime University, Shitsukawa, Tohon City, Ehime 791-0295, Japan.
| | - Masayuki Hino
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Yusuke Murakami
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
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Yamada K, Abe Y, Yanagibashi Y, Hyakumachi T, Nakamura H. Risk Factors for Reoperation at Same Level after Decompression Surgery for Lumbar Spinal Stenosis in Patients with Diffuse Idiopathic Skeletal Hyperostosis Extended to the Lumbar Segments. Spine Surg Relat Res 2021; 5:381-389. [PMID: 34966864 PMCID: PMC8668211 DOI: 10.22603/ssrr.2020-0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Diffuse idiopathic skeletal hyperostosis (DISH) extended to the lumbar segments (L-DISH) reportedly has adverse effects on the surgical outcomes of lumbar spinal stenosis (LSS). However, the risk factors in patients with L-DISH have not been clarified. The purpose of this study was to investigate the long-term risk factors for reoperation at the same level after decompression surgery alone for LSS in patients with L-DISH in a retrospective cohort study. Methods A postoperative postal survey was sent to 1,150 consecutive patients who underwent decompression surgery alone for LSS from 2002 to 2010. Among all respondents, patients who exhibited L-DISH by preoperative total spine X-ray were included in this study. We investigated risk factors for reoperation at the same level as the initial surgery among various demographic and radiological parameters, including the lumbar ossification condition and computed tomography (CT) or magnetic resonance imaging findings. Results A total of 57 patients were analyzed. Reoperations at the same level as that of the index surgery were performed in 10 patients (17.5%) and at 11 levels within a mean of 9.2 years. Cox proportional hazard regression analysis indicated that the independent risk factors for reoperation were a sagittal rotation angle ≥10° (adjusted hazard ratio: 5.17) and facet opening on CT (adjusted hazard ratio: 4.82). Neither sagittal translation nor the ossification condition in the lumbar segments affected reoperations. Conclusions A sagittal rotation angle ≥10° and facet opening on preoperative CT were risk factors for reoperation at the same level as that of the index surgery in patients with L-DISH. The surgical strategy should be carefully considered in those patients.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, Fuchu Hospital, Izumi, Japan.,Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Japan
| | | | | | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
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Zamora AC, Tallman SD. The role of diffuse idiopathic skeletal hyperostosis (DISH) in positive identification. J Forensic Sci 2021; 67:877-888. [DOI: 10.1111/1556-4029.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alyssa C. Zamora
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
| | - Sean D. Tallman
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
- Department of Anthropology Boston University Boston USA
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13
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Diffuse Idiopathic Skeletal Hyperostosis of the Spine: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2021; 29:1044-1051. [PMID: 34559699 DOI: 10.5435/jaaos-d-20-01344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is an ankylosing condition affecting up to 32.5% of the general cohort. Although often asymptomatic, affected individuals may present with back pain, stiffness, dysphagia, functional decline, and neurologic deficits. Radiographically, DISH is characterized by flowing ossifications along the anterior spine spanning ≥4 vertebral bodies. Although the etiology of DISH remains unknown, diabetes mellitus and other metabolic derangements are strongly associated with DISH. Importantly, spinal ankylosis in DISH predisposes patients to unstable spine fractures from low-energy trauma, and careful consideration must be taken in managing these patients. This article reviews the epidemiology and pathophysiology of DISH, and its clinical findings, diagnostic criteria, and management.
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14
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Nakajima H, Honjoh K, Watanabe S, Kubota A, Matsumine A. Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment. J Neurosurg Spine 2021:1-7. [PMID: 34653984 DOI: 10.3171/2021.5.spine21412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH. METHODS A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors' hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups. RESULTS L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery. CONCLUSIONS The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.
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Clavaguera T, Reyner P, Buxó M, Valls M, Armengol E, Juanola X. Identifying Clinicoradiological Phenotypes in Diffuse Idiopathic Skeletal Hyperostosis: A Cross-Sectional Study. Medicina (B Aires) 2021; 57:medicina57101005. [PMID: 34684042 PMCID: PMC8538653 DOI: 10.3390/medicina57101005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is a bone formation disease in which only skeletal signs are considered in classification criteria. The aim of the study was to describe different phenotypes in DISH patients based on clinicoradiological features. Materials and Methods: We evaluated 97 patients who met the Resnick or modified Utsinger classification criteria for DISH and were diagnosed at our hospital from 2004 to 2015. Patients were stratified into: (a) peripheral pattern (PP)—Resnick criteria not met but presenting ≥3 peripheral enthesopathies; (b) axial pattern (AP)—Resnick criteria met but <3 enthesopathies; and (c) mixed pattern (MP)—Resnick criteria met with ≥3 enthesopathies. Statistical analysis was carried out to identify variables that might predict classification in a given group. Results: Fifty-six of the 97 patients included (57.7%) were male and 72.2% fulfilled the Resnick criteria. Applying our classification, 39.7% were stratified as MP, 30.9% as AP and 29.4% as PP. Clinical enthesopathy was reported in 40.2% of patients during the course of the disease. Sixty-eight patients were included in a comparative analysis of variables between DISH patterns. The results showed a predominance of women (p < 0.004), early onset (p < 0.03), hip involvement (p < 0.003) and enthesitis (p < 0.001) as hallmarks of PP. Asymptomatic patients were most frequently observed in AP (28.6%, MP 3.8%, PP 5.0%) while MP was characterized by a more extensive disease. Conclusions: We believe DISH has distinct phenotypes and describe a PP phenotype that is not usually considered. Extravertebral manifestations should be included in the new classification criteria in order to cover the entire spectrum of the disease.
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Affiliation(s)
- Teresa Clavaguera
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
- Correspondence: or ; Tel.: +34-972-94-02-00
| | - Patrícia Reyner
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
| | - Maria Buxó
- Servei de Biostadística, Institut d’Investigació Biomèdica de Girona (IDIBGI), 17003 Girona, Spain;
| | - Marta Valls
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
| | | | - Xavier Juanola
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain;
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16
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Murakami Y, Morino T, Hino M, Misaki H, Miura H. Progression of Ossification of the Anterior Longitudinal Ligament Associated With Diffuse Idiopathic Skeletal Hyperostosis by Age: A Study of Computed Tomography Findings Over 5 Years. Global Spine J 2021; 11:656-661. [PMID: 32875895 PMCID: PMC8165915 DOI: 10.1177/2192568220918817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE To investigate whether the progression of anterior longitudinal ligament ossification varies by age among patients with diffuse idiopathic skeletal hyperostosis (DISH). METHODS Of the patients who underwent computed tomography (CT) of the thoracic to pelvic region at least twice from 2009 to 2018, 191 who underwent CT at an interval of 5 years and 0 months to 5 years and 2 months were enrolled (87 men and 104 women). Sex, age at the time of the first CT scan, the presence/absence of DISH, level of complete vertebral body fusion associated with DISH, and extent of ligament ossification using the modified Mata scoring system were investigated. RESULTS DISHs were detected in 53 (27.7%) of 191 patients. The score of ligament ossification increased over time in 35 (66%) of 53 patients; 93 intervertebral spaces were affected. The percentage of completely fused intervertebral spaces increased by 6.7% from 31.3% to 38.0% over time. The increase in score for all intervertebral spaces in individual patients was significantly greater in the ≤70 years old group (2.7 ± 2.8 points, n = 28) than in the ≥71 years old group (1.2 ± 1.4 points; n = 25; P = .028). The mean age of patients with a recorded score that increased by ≥1 point was 67.4 years and that of patients without any change in the score was 73.3 years (P = .036). Thus, patients with recorded changes in the score were younger. CONCLUSION During the approximately 5-year period, ossification progressed more in younger patients than in older patients.
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Affiliation(s)
- Yusuke Murakami
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan,Yusuke Murakami, Department of Orthopedic Surgery, Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime 791-0295, Japan.
| | - Tadao Morino
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Masayuki Hino
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Misaki
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
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17
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Pathomechanism and prevention of further surgery after posterior decompression for lumbar spinal canal stenosis in patients with diffuse idiopathic skeletal hyperostosis. Spine J 2021; 21:955-962. [PMID: 33453385 DOI: 10.1016/j.spinee.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery after posterior decompression without fusion for patients with lumbar spinal canal stenosis (LSS). However, a strategy to prevent revision surgery has not been described. PURPOSE The aim of this study was to review clinical and imaging findings in LSS patients with DISH extending to the lumbar segment and to propose countermeasures for prevention of revision surgery. STUDY DESIGN A retrospective study. PATIENTS SAMPLE A total of 613 consecutive patients with LSS underwent posterior decompression without fusion at our hospital and had a minimum follow-up period of 2 years. We defined patients with DISH bridging to the lumbar segment as L-DISH cases (group D, n=111), and those without as non-L-DISH cases (group N, n=502). OUTCOME MEASURE Demographic data including the rate of revision surgery, neurological examination using Japanese Orthopaedic Association score, radiological studies comprised plain lumbar radiography, CT, and high-resolution MRI were assessed. METHODS Clinical features and imaging findings were compared in patients with and without L-DISH. Revision surgery and surgical procedures (conventional laminotomy or lumbar spinous process-splitting [split] laminotomy) were examined in the two groups. No funding was received for this study. RESULTS L-DISH from L2 to L4 was a risk factor for disc degeneration such as a vacuum phenomenon and for further surgical treatment. The rate of revision surgery was higher in group D than in group N (9.0% vs. 4.0%, p=.026). There was no significant difference in this rate for patients in groups D and N who underwent conventional laminotomy; however, for those who underwent split laminotomy, the rate was significantly higher in group D (16.7% vs. 2.1%, p=.0006). Furthermore, the rate of revision surgery after split laminotomy at a lower segment adjacent to L-DISH was significantly higher than that after conventional laminotomy (37.5% vs. 7.7%, p=.037). CONCLUSIONS A negative impact of lumbar spinous process-splitting laminotomy was found, especially with decompression at a lower segment adjacent to L-DISH. In such cases, surgery sparing the osteoligamentous structures at midline, including the spinous process and supra- and interspinous ligaments, should be selected.
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18
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Castells Navarro L, Buckberry J. Back to the beginning: Identifying lesions of diffuse idiopathic skeletal hyperostosis prior to vertebral ankylosis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 28:59-68. [PMID: 31951851 DOI: 10.1016/j.ijpp.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/29/2019] [Accepted: 12/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To better understand the pathogenesis of DISH, identifying early or pre-DISH lesions in the spine and investigating the relationship between spinal and extra-spinal manifestations of DISH. MATERIAL 44 skeletonized individuals with DISH from the WM Bass Donated Skeletal Collection. METHODS For each vertebra, location, extension, point of origin and appearance of vertebral outgrowths were recorded. The size of the enthesophytes at the olecranon process, patella and calcaneal tuberosity was measured with digital callipers. RESULTS At either end of the DISH-ankylosed segment, isolated vertical outgrowths arising from the central third of the anterior aspect of the vertebral body can usually be observed. These bone outgrowths show a well-organized external cortical layer, an internal structure of trabecular bone and usually are unaccompanied by or show minimal associated endplate degeneration. Analysis of the relationship between spinal and extra-spinal manifestations (ESM) suggests great inter-individual variability. No correlation between any ESM and the stage of spinal DISH was found. CONCLUSIONS Small isolated outgrowths represent the earliest stages of the spinal manifestations of DISH. The use of ESM as an indicator of DISH should be undertaken with great caution until the relationship between these two features is understood. SIGNIFICANCE Improved accuracy of paleopathological diagnostic criteria of DISH. LIMITATIONS Small sample comprised of only individuals with DISH. FUTURE RESEARCH: micro-CT analysis to investigate the internal structure of the spinal lesions. Analysis of extra-spinal enthesophytes in individuals with and without DISH to understand their pathogenesis and association with the spinal lesions in individuals with DISH.
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Affiliation(s)
- Laura Castells Navarro
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford, BD7 1DP, UK.
| | - Jo Buckberry
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford, BD7 1DP, UK
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19
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Chaput CD, Siddiqui M, Rahm MD. Obesity and calcification of the ligaments of the spine: a comprehensive CT analysis of the entire spine in a random trauma population. Spine J 2019; 19:1346-1353. [PMID: 30902702 DOI: 10.1016/j.spinee.2019.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Obesity, which is currently surging to epidemic levels within the United States, has been linked to hyperostotic conditions like diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL). Excess adipose tissue and insulin-resistance may cause a systemic increase in serum levels of proinflammatory cytokines and these signals can affect bone metabolism. Spinal ligaments and discs may have receptors for these signaling molecules. Anecdotal observations at this institution suggested that there is a clinically important subset of younger patients with obesity and multilevel stenosis in the presence of unusual calcification of the spinal ligaments that is distinct from DISH. PURPOSE To determine if there is an association between truncal obesity and calcifications of the spine in nonelderly adults. STUDY DESIGN/SETTING This is a retrospective analysis of 214 sequential trauma patients between the ages of 29 and 50. Patients' age, sex, truncal obesity, history of hypertension, and diabetes were assessed for association with ligamentous calcification of the spine. PATIENT SAMPLE Sequential trauma patients were chosen from our institution's trauma database between 2006 and 2007. METHODS Full spine computed tomography (CT) imaging was examined for bone formation in the region of the anterior longitudinal ligament (ALL) and annulus, posterior longitudinal ligament (PLL) and annulus, and the ligamentum flavum (LF). Visceral and subcutaneous abdominal fat were also evaluated. The authors report no study funding sources or conflicts of interest. OUTCOME MEASURES Calcification of the ALL, PLL, and LF were assigned a score at each level and then combined for a total calcification score (TCS) for the entire spine. Obesity was estimated using a truncal body mass index (TBMI) by using a previously validated CT derived truncal total adiposity volume (TAV). RESULTS ALL calcification was associated with age, male gender, hypertension, and increased adiposity. PLL calcification was significantly associated with age and hypertension. LF calcification was only associated with increased obesity. CONCLUSIONS In our analysis of nonelderly patients, LF calcification was independently associated with truncal obesity. This implies obesity plays a greater role in calcification than could be accounted for by simply age-related degeneration or gender.
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Affiliation(s)
- Christopher D Chaput
- University of Texas Health Science Center at San Antonio, Address: 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
| | - Mehdi Siddiqui
- University of Texas Health Science Center at San Antonio, Address: 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
| | - Mark D Rahm
- Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Address: 2401 S 31(st) St, Temple, TX 76508, USA
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Okano I, Tachibana T, Nishi M, Midorikawa Y, Hoshino Y, Sawada T, Kudo Y, Toyone T, Inagaki K. Conservative treatment for stable low-energy thoracolumbar vertebral fractures in nonfused segments among elderly patients with diffuse idiopathic skeletal hyperostosis: A matched case-control study. Medicine (Baltimore) 2019; 98:e16032. [PMID: 31192958 PMCID: PMC6587625 DOI: 10.1097/md.0000000000016032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is the spontaneous osseous fusion of the spine with anterior bridging osteophytes. It is well-known that conservative treatment for vertebral fractures of fused segment among DISH spines is associated with worse clinical outcomes. However, the prognosis of conservatively treated stable vertebral fractures in neighboring nonfused segments among DISH spines is still unknown. The purpose of this study was to analyze the results of conservative treatment of stable low-energy thoracolumbar (TL) vertebral fracture in nonfused segments among patients with DISH lesions.A total of 390 consecutive patients who visited an emergency department by ambulance with spinal trauma between 2013 and 2017 were retrospectively reviewed. The diagnosis of DISH was determined based on fused spinal segments with bridging osteophytes in at least 3 adjacent vertebrae. For each case of stable TL vertebral fractures in nonfused segments of the DISH spine, we identified 2 age-, sex-, and fracture lesion-matched non-DISH controls who underwent conservative treatment for low-energy TL vertebral fractures during the same period.Of the 33 identified cases of TL fractures with DISH, 14 met our inclusion criteria. The bony union rates of the DISH group and control group were 57% and 75% at the 3-month follow-up examination (P = .38) and 69% and 100% at the 6-month follow-up examination (P = .02), respectively. Among the 13 patients with fractures below the TL junction, fused segments were not diagnosable based on the initial standard radiographs of the lumbar spine for 61.5% of patients.Although this study design was exploratory and the sample size was small, our results suggest that with conservative treatment, stable fractures in nonfused segments in the DISH spine might have a worse prognosis than ordinary osteoporotic vertebral fractures. The diagnosis of coexisting DISH lesions can be missed when only radiographs of the lumbar spine are used to determine the diagnosis.
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Affiliation(s)
- Ichiro Okano
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima
| | - Tetsuya Tachibana
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima
| | - Masanori Nishi
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima
| | - Yuki Midorikawa
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima
| | - Yushi Hoshino
- Department of Orthopaedic Surgery, Showa University Koto Toyosu Hospital, Koto-ku
| | - Takatoshi Sawada
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Koriyama, Fukushima
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Shinagama-ku, Tokyo, Japan
| | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Showa University School of Medicine, Shinagama-ku, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Shinagama-ku, Tokyo, Japan
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21
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Fournier DE, Norley CJD, Pollmann SI, Bailey CS, Al Helal F, Willmore KE, Holdsworth DW, Dixon SJ, Séguin CA. Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro-ct analysis. J Orthop Res 2019; 37:717-726. [PMID: 30756413 DOI: 10.1002/jor.24247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spondyloarthropathy identified radiographically by calcification of the ligaments and/or entheses along the anterolateral aspect of the vertebral column. The etiology and pathogenesis of calcifications are unknown, and the diagnosis of DISH is currently based on radiographic criteria associated with advanced disease. To characterize the features of calcifications associated with DISH, we used micro-computed tomographic imaging to evaluate a cohort of 19 human cadaveric vertebral columns. Fifty-three percent of the cohort (n = 10; 3 females, 7 males, mean age of death = 81 years, range 67-94) met the radiographic criteria for DISH, with calcification of four or more contiguous vertebral segments. In almost all cases, the lower thoracic regions (T8-12) were affected by calcifications, consisting primarily of large, horizontal outgrowths of bony material. In contrast, calcifications localized to the upper thoracic regions demonstrated variability in their presentation and were categorized as either "continuous vertical bands" or "discontinuous-patchy" lesions. In addition to the variable morphology of the calcifications, our analysis demonstrated remarkable heterogeneity in the densities of calcifications, ranging from internal components below the density of cortical bone to regions of hyper-dense material that exceeded cortical bone. These findings establish that the current radiographic criteria for DISH capture heterogeneous presentations of ectopic spine calcification that can be differentiated based on morphology and density. These findings may indicate a naturally heterogenous disease, potential stage(s) in the natural progression of DISH, or distinct pathologies of ectopic calcifications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Dale E Fournier
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - Chris J D Norley
- Imaging Research Laboratories, John P. Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Steven I Pollmann
- Imaging Research Laboratories, John P. Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Christopher S Bailey
- Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - Fahad Al Helal
- Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Katherine E Willmore
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - David W Holdsworth
- Imaging Research Laboratories, John P. Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - S Jeffrey Dixon
- Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - Cheryle A Séguin
- Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
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22
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Pini SF, Acosta-Ramón V, Tobalina-Segura M, Pariente-Rodrigo E, Rueda-Gotor J, Olmos-Martínez JM, Hernández-Hernández JL. Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection? Clin Rheumatol 2018; 38:1155-1162. [PMID: 30564945 DOI: 10.1007/s10067-018-4398-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 12/30/2022]
Abstract
Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50 years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9 years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.
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Affiliation(s)
| | | | | | - Emilio Pariente-Rodrigo
- Camargo Primary Health Care Centre and University of Cantabria, Avda Bilbao, s/n 39600, Muriedas, Cantabria, Spain
| | - Javier Rueda-Gotor
- Musculoskeletal Unit. Department of Rheumatology, University Hospital Marqués de Valdecilla, 39008, Santander, Spain
| | - José Manuel Olmos-Martínez
- Bone Metabolism Unit. Department of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL and University of Cantabria, 39008, Santander, Spain
| | - José Luis Hernández-Hernández
- Bone Metabolism Unit. Department of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL and University of Cantabria, 39008, Santander, Spain.
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23
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Milner GR, Boldsen JL, Ousley SD, Getz SM, Weise S, Tarp P, Steadman DW. Selective mortality in middle-aged American women with Diffuse Idiopathic Skeletal Hyperostosis (DISH). PLoS One 2018; 13:e0202283. [PMID: 30153267 PMCID: PMC6112637 DOI: 10.1371/journal.pone.0202283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE A mortality sample of white American male and female skeletons was examined to illustrate a simple means of identifying skeletal conditions associated with an increased risk of dying relatively early in adulthood and to determine if males and females with Diffuse Idiopathic Skeletal Hyperostosis (DISH) displayed the same general age-specific pattern of mortality. METHODS Age-specific probability distributions for DISH were generated from 416 white Americans who died from the 1980s to the present, and whose remains were donated to the University of Tennessee Forensic Anthropology Center. The age-specific frequency of DISH is analyzed using an empirical smoothing algorithm. Doing so allows for the identification of deviations (i.e., local maxima) from monotonically increasing age-specific probabilities. RESULTS In females (N = 199), there is a peak in the frequency of individuals with DISH around 60 years of age where 37.0% of the individuals have DISH. It is matched only by the frequency (38.7%) in the oldest females, those over 85 years old. In contrast, DISH frequencies for males (N = 217) increase monotonically with advancing age, reaching 62.5% in the ≥86 years age group. There was an association between DISH and high body weight in women, particularly those who died before they reached the age of 75. CONCLUSIONS Early-onset DISH in white American women is associated with an increased risk of dying indicated by a local maximum in the probability curve. Should this finding be replicated in additional mortality samples and the reason DISH is associated with early death is established, beyond being heavy, this radiologically visible ossification of the spine could be a potential component of health-monitoring programs for middle-aged women.
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Affiliation(s)
- George R. Milner
- Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Jesper L. Boldsen
- Unit of Anthropology, ADBOU, Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | - Stephen D. Ousley
- Department of Mathematics and Information Science, Mercyhurst University, Erie, Pennsylvania, United States of America
| | - Sara M. Getz
- Department of Anthropology, Idaho State University, Pocatello, Idaho, United States of America
| | - Svenja Weise
- Unit of Anthropology, ADBOU, Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | - Peter Tarp
- Unit of Anthropology, ADBOU, Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark
| | - Dawnie W. Steadman
- Forensic Anthropology Center, Department of Anthropology, University of Tennessee, Knoxville, Tennessee, United States of America
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24
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Hiyama A, Katoh H, Sakai D, Sato M, Tanaka M, Watanabe M. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects. BMC Musculoskelet Disord 2018; 19:178. [PMID: 29848322 PMCID: PMC5977547 DOI: 10.1186/s12891-018-2108-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/22/2018] [Indexed: 01/26/2023] Open
Abstract
Background Computed tomography (CT) analyses have reported that the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in Japan is 8.7–27.1%. However, these data were obtained using chest-abdominal CT, and no evaluations of sagittal, coronal, and axial images using whole-spine CT have been reported. The aim of this study was to investigate the prevalence and characteristic of DISH by whole spinal CT. Methods Participants were patients who had experienced trauma who had undergone whole-spine CT scanning based on the initial clinical practice guidelines for trauma in our institute from April 2015 to February 2018. The subjects were > 20 years old and 1479 were included in the analysis. The presence and distribution of DISH and clinical parameters such as age and sex were reviewed retrospectively according to the location of DISH. Results The overall prevalence of DISH was 19.5% (n = 289). Subjects with DISH were older than those without. DISH was located in the thoracic spine in 65.1% and thoracolumbar spine in 24.2% of patients. More than 80% of ligamentous ossifications associated with DISH occurred at T8 (n = 255, 88%), T9 (n = 262, 91%), and T10 (n = 247, 85%). Most of the ossification occurred to the right anterior of the vertebral body, and there were few ossifications in the areas in contact with the artery and vein. Conclusions The prevalence of DISH based on whole-spine CT was 19.5%. Ossification was noted more often at T8, T9, and T10, and to the right anterior of the vertebral body. It is for the first time report that we have studied the location of ossification in detail using the axial images of whole spine CT. We hope this study will enhance the understanding of the characteristics of DISH. Electronic supplementary material The online version of this article (10.1186/s12891-018-2108-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Tanaka
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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25
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Kuperus JS, Buckens CF, Šprem J, Oner FC, de Jong PA, Verlaan JJ. The Natural Course of Diffuse Idiopathic Skeletal Hyperostosis in the Thoracic Spine of Adult Males. J Rheumatol 2018; 45:1116-1123. [DOI: 10.3899/jrheum.171091] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/22/2022]
Abstract
Objective.Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by flowing bony bridges on the right side of the spine. Knowledge of the development of these spinal bridges is limited. The current longitudinal computed tomography (CT) study was designed to bridge this gap.Methods.Chest CT scans from elderly males with 2 scans (interval ≥ 2.5 yrs) were retrospectively included. Using the Resnick criteria, a pre-DISH group and a definite DISH group were identified. A scoring system based on the completeness of a bone bridge (score 0–3), extent of fluency, and location of the new bone was created to evaluate the progression of bone formation.Results.In total, 145 of 1367 subjects were allocated to the DISH groups with a mean followup period of 5 years. Overall prevalence of a complete bone bridge increased in the pre-DISH group (11.3% to 31.0%) and in the definite DISH group (45.0% to 55.8%). The mean bridge score increased significantly in both the pre-DISH and definite DISH group (p < 0.001). The new bone gradually became more flowing and expanded circumferentially.Conclusion.Over the mean course of 5 years, the new bone developed from incomplete, pointy bone bridges to more flowing complete bridges. This suggests an ongoing and measurable bone-forming process that continues to progress, also in established cases of DISH.
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26
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Hiratsuka S, Takahata M, Shimizu T, Hamano H, Ota M, Sato D, Iwasaki N. Drug therapy targeting pyrophosphate slows the ossification of spinal ligaments in twy mice. J Orthop Res 2018; 36:1256-1261. [PMID: 28940647 DOI: 10.1002/jor.23743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
The lack of an effective drug therapy against ossification of spinal ligament (OSL) warrants investigation into the therapeutic target of this disease. An endogenous inhibitor of biomineralization, pyrophosphate (PPi) is a potential therapy for ectopic ossification; however, exogenous PPi is rapidly hydrolyzed by tissue non-specific alkaline phosphatase (TNAP) present in body fluids. In this study, we examined whether a drug therapy targeting PPi is efficacious for the treatment of OSL using the Enpp1ttw/ttw (twy) mouse model. Twenty male twy mice were randomized into four groups: (i) vehicle (Control); (ii) alkaline phosphatase inhibitor levamisole (5 mg/kg/day sc continuously); (iii) levamisole + exogenous PPi (160 µmol/kg/day sc continuously); and (iv) nuclear retinoic acid receptor-γ (RARγ) agonist (6 µg/kg sc daily). The RARγ agonist, which is a proven inhibitor of ectopic endochondral ossification, was used as a positive control. Treatments commenced when the mice were 5 weeks of age and continued for 4 weeks. Longitudinal micro-computed tomography and postmortem histological analysis were performed. Administration of levamisole alone and in combination with PPi increased serum PPi concentration by 17% and 52%, respectively, compared to that in vehicle-treated mice. The development of OSL in twy mice was suppressed by levamisole + PPi and RARγ agonist treatments, but not by levamisole alone. The levamisole + PPi therapy did not cause osteoporosis, whereas RARγ agonist-treated mice developed osteoporosis. Treatment of twy mice with levamisole in combination with exogenous PPi increased serum PPi level, which slowed the progression of OSL without producing adverse effect on bone. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1256-1261, 2018.
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Affiliation(s)
- Shigeto Hiratsuka
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroki Hamano
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Masahiro Ota
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Dai Sato
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
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27
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Kuperus JS, de Gendt EEA, Oner FC, de Jong PA, Buckens SCFM, van der Merwe AE, Maat GJR, Regan EA, Resnick DL, Mader R, Verlaan JJ. Classification criteria for diffuse idiopathic skeletal hyperostosis: a lack of consensus. Rheumatology (Oxford) 2017; 56:1123-1134. [PMID: 28371859 DOI: 10.1093/rheumatology/kex056] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives DISH is a condition characterized by flowing ossifications of the spine with or without ossifications of entheses elsewhere in the body. Studies on the prevalence and pathogenesis of DISH use a variety of partly overlapping combinations of classification criteria, making meaningful comparisons across the literature difficult. The aim of this study was to systematically summarize the available criteria to support the development of a more uniform set of diagnostic/classification criteria. Methods A search was performed in Pubmed, Embase, Cochrane Library and Web of Science using the term DISH and its synonyms. Articles were included when two independent observers agreed that the articles proposed a new set of classification criteria for DISH. All retrieved articles were evaluated for methodological quality, and the presented criteria were extracted. Results A total of 24 articles met the inclusion criteria. In all articles, spinal hyperostosis was required for the diagnosis of DISH. Peripheral, extraspinal manifestations were included as a (co-)requirement for the diagnosis DISH in five articles. Most discrepancies revolved around the threshold for the number of vertebral bodies affected and to defining different developmental phases of DISH. More than half of the retrieved articles described a dichotomous set of criteria and did not consider the progressive character of DISH. Conclusion This systematic review summarizes the available different classification criteria for DISH, which highlights the lack of consensus on the diagnosis of (early) DISH. Consensus criteria, including consecutive phases of new bone formation that characterize DISH, can be developed based upon established diagnostic/classification criteria.
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Affiliation(s)
| | | | | | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | | | | | - George J R Maat
- Department of Anatomy, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Donald L Resnick
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Reuven Mader
- Department of Rheumatology, Ha'Emek Medical Center, Afula, Israel
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Prevalence of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Spinal Disorders. Asian Spine J 2017; 11:63-70. [PMID: 28243371 PMCID: PMC5326734 DOI: 10.4184/asj.2017.11.1.63] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 01/26/2023] Open
Abstract
Study Design Retrospective cohort study. Purpose The purpose of this study was to evaluate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with spinal diseases determined by roentgen images of the whole spine. Overview of Literature Although several studies have investigated the prevalence of DISH in healthy subjects, no detailed data have been reported on the prevalence of DISH in patients with degenerative spinal disorders. Methods Standing whole-spine roentgen images of 345 consecutive patients who underwent surgery in our hospital were obtained. Patients aged <18 years or with congenital spinal disease, metastatic spinal tumors, or inflammatory spinal disease were excluded. In total, 281 patients were eligible for inclusion. The presence of DISH was assessed according to Resnick's criteria and Mata's scoring system. The prevalence, location, and numbers of fused vertebral bodies of DISH were recorded. Results DISH was present in 25.6% of patients (72/281). The prevalence of DISH in the 41–49, 50–59, 60–69, 70–79, and ≥80 year age groups was 8.3% (2/24), 9.8% (5/51), 16.0% (12/75), 49.5% (48/97), and 33.3% (4/12), respectively; the prevalence increased with age. The average number of fused vertebral bodies was 7.5. More than 80% of DISH was located from T7 to T11, and more than 95% of DISH was located at T9/10. Patients with DISH were significantly older (71.1 years vs. 60.9 years, p<0.05), and men were more likely to have DISH than women (p<0.05). Conclusions In patients with degenerative spinal diseases with DISH, fused vertebrae were found most frequently in the lower thoracic spine, and their prevalence increased with age. DISH may be an age-related skeletal disorder with a higher overall prevalence in patients with spinal disorders than that in healthy subjects.
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29
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Vaishya R, Vijay V, Nwagbara IC, Agarwal AK. Diffuse idiopathic skeletal hyperostosis (DISH) - A common but less known cause of back pain. J Clin Orthop Trauma 2017; 8:191-196. [PMID: 28721001 PMCID: PMC5498746 DOI: 10.1016/j.jcot.2016.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/12/2016] [Indexed: 12/29/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory disease of an unknown aetiology. It is characterized by ossification of the enthesis and may significantly affect the quality of life of the affected individuals. Despite the fact that this disease was first described more than 60 years ago and is a relatively common condition in the society, its awareness among clinician is still limited. An awareness of this entity and its mimicking conditions is essential so as to reach to an early diagnosis and avoid unnecessary investigations and treatment.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India,Corresponding author.
| | - Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
| | | | - Amit K. Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
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30
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Tauchi R, Lee SH, Peters C, Imagama S, Ishiguro N, Riew KD. Cervical Myeloradiculopathy due to Ossification of the Posterior Longitudinal Ligament with versus without Diffuse Idiopathic Spinal Hyperostosis. Global Spine J 2016; 6:350-6. [PMID: 27190737 PMCID: PMC4868586 DOI: 10.1055/s-0035-1563722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/22/2015] [Indexed: 12/05/2022] Open
Abstract
Study Design Retrospective study. Objectives Assess demographics, ossification characteristics, surgical outcomes, and complications in patients with both diffuse idiopathic spinal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) compared with patients who only have OPLL. Methods Clinical charts and radiographs of all patients treated surgically from February 2004 to July 2012 for cervical myeloradiculopathy due to DISH with OPLL or OPLL alone were reviewed retrospectively. All patients were observed for a minimum of 1 year. Pre- and postoperative Nurick grades were assessed for all patients. Results Forty-nine patients underwent surgical treatment for cervical myeloradiculopathy due to OPLL, and 8 also had DISH (average 58.9 years, range 37 to 70). The DISH with OPLL group had a significantly higher proportion of subjects with diabetes mellitus (50 versus 9.8% in the OPLL-only group). Everyone in the DISH with OPLL group had continuous or mixed-type OPLL, whereas 78% of patients in the OPLL-only group had primarily segmental type. Operative treatments for patients in the DISH with OPLL group included laminoplasty, anterior decompression and fusion, and posterior laminectomy with fusion. By Nurick grade, 5 patients improved and 3 showed no change. Conclusion Patients with both DISH and OPLL had a higher prevalence of diabetes mellitus and either continuous or mixed-type OPLL classifications. Surgical outcomes were mostly satisfactory; there was no aggravation of symptoms after surgery during the follow up period.
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Affiliation(s)
- Ryoji Tauchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,Address for correspondence Ryoji Tauchi, MD Department of Orthopaedic SurgeryNagoya University Graduate School of Medicine, NagoyaJapan
| | - Sang-Hun Lee
- Department of Orthopaedic Surgery, Kyung-Hee University, Seoul, Korea
| | - Colleen Peters
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, United States
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K. Daniel Riew
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, United States
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31
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Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol 2016; 27:188-194. [PMID: 27097788 PMCID: PMC5127853 DOI: 10.1007/s00330-016-4355-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/26/2022]
Abstract
Objective To evaluate and improve the interobserver agreement for the CT-based diagnosis of diffuse idiopathic skeletal hyperostosis (DISH). Methods Six hundred participants of the CT arm of a lung cancer screening trial were randomly divided into two groups. The first 300 CTs were scored by five observers for the presence of DISH based on the original Resnick criteria for radiographs. After analysis of the data a consensus meeting was organised and the criteria were slightly modified regarding the definition of ‘contiguous’, the definition of ‘flowing ossifications’ and the viewing plane and window level. Subsequently, the second set of 300 CTs was scored by the same observers. κ ≥ 0.61 was considered good agreement. Results The 600 male participants were on average 63.5 (SD 5.3) years old and had smoked on average 38.0 pack-years. In the first round κ values ranged from 0.32 to 0.74 and 7 out of 10 values were below 0.61. After the consensus meeting the interobserver agreement ranged from 0.51 to 0.86 and 3 out of 10 values were below 0.61. The agreement improved significantly. Conclusions This is the first study that reports interobserver agreement for the diagnosis of DISH on chest CT, showing mostly good agreement for modified Resnick criteria. Key Points • DISH is diagnosed on fluoroscopic and radiographic examinations using Resnick criteria • Evaluation of DISH on chest CT was modestly reproducible with the Resnick criteria • A consensus meeting and Resnick criteria modification improved inter-rater reliability for DISH • Reproducible CT criteria for DISH aids research into this poorly understood entity
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Hamano H, Takahata M, Ota M, Hiratsuka S, Shimizu T, Kameda Y, Iwasaki N. Teriparatide Improves Trabecular Osteoporosis but Simultaneously Promotes Ankylosis of the Spine in the Twy Mouse Model for Diffuse Idiopathic Skeletal Hyperostosis. Calcif Tissue Int 2016; 98:140-8. [PMID: 26463185 DOI: 10.1007/s00223-015-0068-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal disorder in the elderly, which can develop into periosteal hyperostosis and paradoxically into immobilization-associated trabecular osteoporosis. The bone anabolic agent, teriparatide (TPD), seems to be a rational treatment for the immobilization-associated osteoporosis. However, it can lead to development of hyperostosis lesions in DISH patients. Here, we demonstrate TPD effectively treats trabecular osteoporosis while simultaneously promoting ankylosis of the spine in DISH model tiptoe-walking Yoshimura (twy) mice, compared with the ICR mice. Eighteen male twy mice were divided into three groups, and ICR mice were used as a normal control. Subcutaneous injections of TPD or phosphate-buffered saline (PBS) were performed according to three dosing regimens; 40 µg/kg once daily (TPD × 1 group), 40 µg/kg three times daily (TPD × 3 group), and PBS (control; Ctl group). Treatment was commenced at the age of 7 weeks and continued for 5 weeks. Micro-computed tomography (µCT) and histological analysis were performed. Longitudinal µCT study revealed that trabecular bone volume in both the vertebral body and distal femur decreased with time in the Ctl group, but increased dramatically in the TPD × 3 group. The twy mice developed ankylosis of the spine, the progression of which was accelerated with TPD therapy. We also confirmed that TPD therapy promoted ossification of spinal ligaments. Histomorphometrical study revealed that TPD treatment increased bone formation at the vertebrae enthesis region and in the trabecular bone. TPD therapy effectively treats trabecular osteoporosis, but potentially promotes ankylosis of the spine in patients with DISH.
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Affiliation(s)
- Hiroki Hamano
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Masahiro Ota
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Shigeto Hiratsuka
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yusuke Kameda
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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Intervertebral bridging ossifications increase the risk of intravertebral cleft formation following a vertebral compression fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:3456-3462. [DOI: 10.1007/s00586-015-4064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/19/2015] [Accepted: 06/07/2015] [Indexed: 02/07/2023]
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Beyeler C, Thomann SR, Gerber NJ, Kunze C, Aeberli D. Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a controlled radiological study. BMC Musculoskelet Disord 2015; 16:119. [PMID: 25982369 PMCID: PMC4493825 DOI: 10.1186/s12891-015-0575-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH) have been described previously. We aimed to assess the prevalence of elbow hyperostotic spurs, to search for sites discriminating for elbow DISH and to analyze the effect of physical activities, handedness and sex. METHODS Out of 284 patients hospitalized for extraskeletal disorders, 85 patients (33 with and 52 without thoracospinal DISH) agreed to bilateral elbow X-rays in two projections. Clinical information was collected by a standardized questionnaire and X-rays were graded blindly. RESULTS A total of 400 hyperostotic spurs (210 unilateral, 95 bilateral) were present at 11 predefined sites. The most frequent sites affected were the olecranon (20.8%), lateral epicondyle (17.8%) and medial epicondyle (15.5%). In carriers of thoracospinal DISH significantly more hyperostotic spurs were present at the lateral and medial epicondyle compared to non-DISH carriers (OR 4.01 [95% CI 1.35-12.34] and 2.88 [1.03-8.24], respectively). The olecranon, lateral and medial epicondyle contributed significantly to the classification of elbow DISH (OR 22.2 [4.1-144.7], 9.6 [1.9-61.2] and 10.1 [2.2-52.1], respectively). The prevalence of elbow hyperostotic spurs was higher in 45 patients with a history of heavy physical activities (24.4% versus 18.0%, OR 1.48 [1.17-1.86]), at the right elbow (24.2% versus 18.6%, OR 1.39 [1.11-1.75]) and in 62 males (22.8% versus 17.6%, OR 1.38 [1.06-1.81]). CONCLUSIONS Hyperostotic spurs at the olecranon, lateral and medial epicondyle had the highest prevalence and disclosed the most pronounced discrimination for elbow DISH. Mechanical factors such as physical activities and handedness, and sex influenced the formation of these spurs.
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Affiliation(s)
- Christine Beyeler
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland.
- Assessment and Evaluation Unit, Institute of Medical Education, University of Bern, Bern, Switzerland.
| | - Sergio R Thomann
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland.
| | - Niklaus J Gerber
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland.
| | - Christine Kunze
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland.
| | - Daniel Aeberli
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland.
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Kagotani R, Yoshida M, Muraki S, Oka H, Hashizume H, Yamada H, Enyo Y, Nagata K, Ishimoto Y, Teraguchi M, Tanaka S, Nakamura K, Kawaguchi H, Akune T, Yoshimura N. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab 2015; 33:221-9. [PMID: 24623190 DOI: 10.1007/s00774-014-0583-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
We aimed to assess the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and its association with lumbar spondylosis (LS) and knee osteoarthritis (KOA) using a population-based cohort study entitled Research on Osteoarthritis/osteoporosis Against Disability (ROAD). In the baseline ROAD study, which was performed between 2005 and 2007, 1,690 participants in mountainous and coastal areas underwent anthropometric measurements and radiographic examinations of the whole spine (cervical, thoracic, and lumbar) and both knees. They also completed an interviewer-administered questionnaire. Presence of DISH was diagnosed according to Resnick criteria, and LS and KOA were defined as Kellgren-Lawrence (KL) grade ≥3. Among the 1,690 participants, whole-spine radiographs of 1,647 individuals (97.5%; 573 men, 1,074 women; mean age, 65.3 years) were evaluated. Prevalence of DISH was 10.8% (men 22.0%, women 4.8%), and was significantly higher in older participants (presence of DISH 72.3 years, absence of DISH 64.4 years) and mainly distributed at the thoracic spine (88.7%). Logistic regression analysis revealed that presence of DISH was significantly associated with older age [+1 year, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.03-1.14], male sex (OR: 5.55, 95% CI: 3.57-8.63), higher body mass index (+1 kg/m(2), OR: 1.08, 95% CI: 1.02-1.14), presence of LS (KL2 vs KL0: 1, OR: 5.50, 95% CI: 2.81-10.8) (KL ≥3 vs KL0: 1, OR: 4.09, 95% CI: 2.08-8.03), and presence of KOA (KL ≥3 vs KL0: 1, OR: 1.89, 95% CI: 1.14-3.10) after adjusting for smoking, alcohol consumption, and residential area (mountainous vs coastal). This cross-sectional population-based study clarified the prevalence of DISH in general inhabitants and its significant association with LS and severe KOA.
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Affiliation(s)
- Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery in short-segment lumbar interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:2514-9. [DOI: 10.1007/s00586-014-3603-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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Yamada K, Toyoda H, Terai H, Takahashi S, Nakamura H. Spinopelvic alignment of diffuse idiopathic skeletal hyperostosis in lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1302-8. [PMID: 24413742 DOI: 10.1007/s00586-013-3154-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE The effect of diffuse idiopathic skeletal hyperostosis (DISH) on spinopelvic alignment in patients with lumbar spinal stenosis (LSS) remains unclear. The aim of this study was to investigate the association between DISH and sagittal spinopelvic alignment in patients undergoing surgery for LSS. METHODS A total of 132 patients aged >40 years who required surgical procedures for LSS were investigated. DISH was defined by Resnick's and Mata's criteria on preoperative standing whole-spine radiographs. We investigated the prevalence and localization of DISH and its relation to preoperative clinical symptoms. Spinopelvic alignment was measured by the sagittal C7 plumb line, lumbar lordosis, thoracic kyphosis, and pelvic parameters. The association between DISH and spinopelvic alignment was analyzed using covariance adjustment for age, sex, spondylolisthesis, and degenerative lumbar scoliosis. RESULTS The prevalence of DISH was 39.4 % and increased with age. Preoperative symptoms showed no differences, regardless of the presence of DISH. Lumbar and thoracic alignment showed kyphotic change in patients with DISH. Patients with DISH with lower fused vertebral ends at the lumbar level (46 % of DISH) still showed significantly decreased lumbar lordosis (p = 0.014) and decreased sacral slope (p = 0.001) after adjusting for age, sex, spondylolisthesis, and degenerative lumbar scoliosis. CONCLUSIONS The prevalence of DISH in patients with LSS was relatively high. Spinopelvic alignment is affected by the presence of DISH, especially in patients with lower fused vertebral ends at the lumbar lesion. These results may offer an explanation for the frequent kyphotic changes in the spine of elderly patients.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Yaniv G, Bader S, Lidar M, Herman A, Shazar N, Aharoni D, Eshed I. The natural course of bridging osteophyte formation in diffuse idiopathic skeletal hyperostosis: retrospective analysis of consecutive CT examinations over 10 years. Rheumatology (Oxford) 2013; 53:1951-7. [DOI: 10.1093/rheumatology/ket335] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Diffuse idiopathic skeletal hyperostosis: Diagnosis in a palaeopathological context. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2012; 63:202-15. [DOI: 10.1016/j.jchb.2012.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 03/26/2012] [Indexed: 11/18/2022]
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Diederichs G, Engelken F, Marshall LM, Peters K, Black DM, Issever AS, Barrett-Connor E, Orwoll E, Hamm B, Link TM. Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density. Osteoporos Int 2011; 22:1789-97. [PMID: 20882271 PMCID: PMC3092929 DOI: 10.1007/s00198-010-1409-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 09/03/2010] [Indexed: 11/16/2022]
Abstract
UNLABELLED Radiographs and spinal bone mineral density (BMD) were evaluated from 342 elderly men regarding possible effects of diffuse idiopathic skeletal hyperostosis (DISH) on vertebral fractures and densitometry measurements. Prevalent vertebral fractures were more frequent among men with DISH compared to men with no DISH even after fracture prevalence was adjusted for BMD. Paravertebral calcifications should be considered in patients with DISH when interpreting BMD measurements because both dual X-ray absorptiometry (DXA) and quantitative CT (QCT) densitometry may not be reliable. INTRODUCTION The purpose of this study is to evaluate the prevalence of DISH in older men and its association with vertebral fractures and with BMD determined by DXA and QCT. METHODS Lateral radiographs of the spine were analyzed in a sample of 342 men aged ≥ 65 years participating in the MrOS Study concerning the presence and grade of DISH and vertebral fractures. Lumbar BMD was measured by both DXA (areal, grams per square centimeter) and QCT (volumetric, grams per cubic centimeter). The association between DISH, BMD, and presence of fractures was studied using χ ( 2 ) and t tests. RESULTS DISH was present in 52% (178/342) of the men. Men with DISH were older (mean, 75.1 vs 73.3, p < 0.05) and more likely to have prevalent fractures (28% vs 20%, p < p = 0.09). BMD assessed with DXA (1.08 vs 1.00 g/cm(2), p ≤ 0.0001), but not with QCT (0.11 vs 0.11 g/cm3, p = 0.65), was significantly higher in men with DISH compared to men without DISH. Significantly lower BMD of men with both DISH and fractures compared to men with DISH but without fractures was only detected by QCT (-25%, 0.09 vs 0.12, p < 0.05). Both DXA BMD and QCT BMD were significantly higher in severe lumbar DISH (+22% and +31%, p < 0.0001), respectively. CONCLUSION DISH was associated with a higher prevalence of vertebral fractures in elderly men. Lumbar ossifications related to DISH should be considered when interpreting BMD measurements to predict their fracture risk.
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Affiliation(s)
- G Diederichs
- Department of Radiology and Biomedical Imaging, Musculoskeletal and Quantitative Imaging Research Group, University of California, China Basin Landing, 185 Berry Street, San Francisco, CA 94107, USA.
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Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum 2011; 41:131-8. [PMID: 21377195 DOI: 10.1016/j.semarthrit.2011.01.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/29/2010] [Accepted: 01/04/2011] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To estimate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a cross-sectional study of elderly men age 65 to 100 years and to examine back and neck pain as possible correlates of DISH. METHODS DISH was defined using Resnick's criteria and scored according to Mata on lateral spine radiographs of 298 randomly selected participants from the MrOS Study. Standardized self-reported questionnaires were used to assess the frequency and severity of back and neck pain, and the relation of these to DISH status was estimated with χ(2) tests, as well as prevalence ratios and 95% confidence intervals using log-binomial regression models. RESULTS DISH was observed in 126 older men (42%), increased with age (30%, 39%, 48%, and 56% for ages 65-69, 70-74, 75-79, and ≥80 respectively), and was positively associated with body mass index (BMI) (P = 0.04) and blood pressure (P = 0.02). Significantly less back pain in the past 12 months was reported among men with DISH as compared to men without (59% vs 71%, P = 0.03), which remained after adjustment for age, BMI, and blood pressure (prevalence ratios = 0.73, 95% confidence interval = 0.57-0.95). Back pain severity (P = 0.07) and frequency (P = 0.06) were also less frequent among men with DISH compared to men without, whereas reported neck pain was similar between groups (P = 0.39). CONCLUSIONS Among community-dwelling elderly men, DISH prevalence is high, increases with age, and is positively associated with BMI and blood pressure. Frequency of self-reported back pain over the past 12 months was lower in older men with DISH as compared to those without DISH.
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The Management of Spinal Injuries in Patients With Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis. ACTA ACUST UNITED AC 2009; 22:77-85. [DOI: 10.1097/bsd.0b013e3181679bcb] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hannallah D, White AP, Goldberg G, Albert TJ. Diffuse Idiopathic Skeletal Hyperostosis. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.oto.2007.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder of unknown etiology that is characterized by back pain and spinal stiffness. There may be mild pain if ankylosis has occurred. The condition is recognized radiographically by the presence of "flowing" ossification along the anterolateral margins of at least four contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. Even in patients who present with either lumbar or cervical complaints, radiographic findings are almost universally seen on the right side of the thoracic spine. Thus, radiographic examination of this area is critical when attempting to establish a diagnosis of DISH. The potential sequelae of hyperostosis in the cervical and lumbar spine include lumbar stenosis, dysphagia, cervical myelopathy, and dense spinal cord injury resulting from even minor trauma. There may be a delay in diagnosis of spinal fractures in a patient with DISH because the patient often has a baseline level of spinal pain and because the injury may be relatively trivial. The incidence of delayed neurologic injury due to such fractures is high as a result of unrecognized instability and subsequent deterioration. Extraspinal manifestations are also numerous and include an increased risk of heterotopic ossification after total hip arthroplasty. Prophylaxis to prevent heterotopic ossification may be indicated for these patients.
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Affiliation(s)
- T A Belanger
- Orthopaedic Surgery, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, 49008, USA
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