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Sulpis B, Neri T, Klasan A, Castel X, Vassal F, Tetard MC. Isolated posterior stabilization in type B and C thoracolumbar fractures associated with ankylosing spine disorders: A single center experience with clinical and radiological outcomes. SICOT J 2024; 10:26. [PMID: 39137794 PMCID: PMC11323833 DOI: 10.1051/sicotj/2024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 05/19/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Fractures in ankylosing spine disorders (ASD) are associated with high complication and mortality rates. During the posterior stabilization of these fractures, reduction is often partial, resulting in the persistence of a significant anterior diastasis. Our objective was to evaluate the safety and efficiency of isolated posterior stabilization in elderly ASD patients, without direct reduction of the anterior diastasis, in terms of clinical and radiological outcomes, complications, and mortality. METHODS This retrospective study included 46 patients, mean age 79.3 years, with ASD, who underwent isolated posterior stabilization, open or percutaneous, for thoracolumbar fractures. The average follow-up was 21.7 months, with a minimum follow-up of 6 months. Autonomy (Parker score) and radiological results (lordotic angulation) were analyzed pre-and post-operatively. RESULTS Autonomy was maintained at the last follow-up, with no significant difference in Parker's score. The consolidation rate was 94.6%. No implant failure was recorded. Despite the absence of an anterior procedure, lordotic angulation was significantly reduced by 2.6° at 6 months (p = 0.02). The rate of surgical complications following open surgeries was 10.9% (n = 5), of which 6.5% were infections. No surgical complications were reported in percutaneous surgeries. The rate of medical complications was 67.4% (n = 31), with a rate of 88.2% in the open surgery group, compared to 55.2% in the percutaneous surgery group. An open approach was associated with a five-fold higher risk of complications (p = 0.049). Nine patients died during follow-up (19.6%). CONCLUSIONS Isolated posterior stabilization in the treatment of thoracolumbar spine fractures in elderly ASD patients is a safe technique promoting autonomy preservation, and high radiological bony healing with acceptable complication and mortality rates. The persistent anterior gap is partially reduced when the spine is loaded and does not seem to require an anterior procedure, thus decreasing complications. Percutaneous surgery should be the technique of choice to reduce surgical complications.
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Affiliation(s)
- Benoit Sulpis
- Jacques Lisfranc Faculty of Medicine, Jean Monnet University 10 Rue de la Marandière 42270 Saint-Priest-en-Jarez France
- Department of Neuro Surgery, University Hospital of Saint Etienne Hôpital Nord 42055 Saint-Étienne Cedex 2 France
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne Saint Etienne France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne Saint Etienne France
- EA 7424 - Inter-University Laboratory of Human Movement Science, University of Lyon - Jean Monnet University Saint-Étienne Cedex 2 France
| | - Antonio Klasan
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH Krankenhausstrasse 9 4020 Linz Austria
- Johannes Kepler University Linz Altenberger Strasse 69 4040 Linz Austria
| | - Xavier Castel
- Department of Neuro Surgery, University Hospital of Saint Etienne Hôpital Nord 42055 Saint-Étienne Cedex 2 France
| | - François Vassal
- Department of Neuro Surgery, University Hospital of Saint Etienne Hôpital Nord 42055 Saint-Étienne Cedex 2 France
| | - Marie Charlotte Tetard
- Department of Neuro Surgery, University Hospital of Saint Etienne Hôpital Nord 42055 Saint-Étienne Cedex 2 France
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Ahmed O, Ramachandran K, Patel Y, Dhanapaul S, Meena J, Shetty AP, Bhari Thippeswamy P, Kanna RM, Rajasekaran S. Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans. Global Spine J 2024; 14:1201-1209. [PMID: 36289007 PMCID: PMC11289539 DOI: 10.1177/21925682221136844] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A Retrospective Study. OBJECTIVE To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions. METHOD A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated. RESULTS Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH. CONCLUSION This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.
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Affiliation(s)
- Owais Ahmed
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Yogin Patel
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Sindhiya Dhanapaul
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Jalaj Meena
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Fournier DE, Battie MC, Séguin CA. Spatiotemporal changes in imaging features associated with diffuse idiopathic skeletal hyperostosis (DISH). RMD Open 2024; 10:e004074. [PMID: 38677879 PMCID: PMC11057289 DOI: 10.1136/rmdopen-2024-004074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVES The purpose of our study was to characterise spatiotemporal features of disease progression in people with diffuse idiopathic skeletal hyperostosis (DISH), early-phase DISH, and those not meeting either criterion who had repeated CT scans of the thoracic spine. METHODS A retrospective study was designed in collaboration with the Rochester Epidemiology Project to evaluate completeness of ectopic bridging across the thoracic spine and corresponding disease status over an average of 2.7 years (range from 0.2 to 15.0 years) in a cohort of 83 female and 74 male individuals. RESULTS Over 15% of individuals displayed changes in imaging features over time that resulted in a revised diagnosis along the continuum of DISH. Early-phase DISH was marked by new involvement of previously unaffected motion segments, estimated to occur over 2.1 years. Advanced presentations of DISH were marked by increased prevalence of complete bridging (average two of three available motion segments), estimated to occur over 2.6-2.9 years. Localised nodules of ectopic mineralisation external to and within the intervertebral disc were regularly observed in early-phase DISH. CONCLUSIONS This is the first characterisation of spatiotemporal features across all phases of DISH, indicating that progression of DISH is characterised by distinct features at different phases along the disease continuum. Localised nodules of mineralisation in the spinal ligaments and within the intervertebral discs coincident with early phases of the disease may be a key factor in the pathogenesis of DISH.
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Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - Michele C Battie
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Cheryle A Séguin
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
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Ploumen RAW, van Wezenbeek MR, Willems PCPH, Gerretsen SC, Ten Bosch JA. How a broken vertebra can lead to a fatal hemorrhage: a case report. Int J Emerg Med 2024; 17:24. [PMID: 38395745 PMCID: PMC10885448 DOI: 10.1186/s12245-024-00594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Unintentional falls are common among the elderly and given the expected increase of the aging population, these falls contribute to a high number of admissions to the emergency department. Relatively low-energy trauma mechanisms can lead to serious injuries in the elderly, with contributing factors being comorbidities, medication use and degenerative abnormalities. CASE PRESENTATION A 94-year-old female suffered an unintentional fall at home. Upon arrival of the ambulance at her house she was hemodynamically stable and mobilized to the gurney with assistance. During primary survey at the emergency department, her blood pressure and oxygen saturation decreased, she was not able to move her legs anymore and lost consciousness. A full-body CTA was performed, which showed a fracture through the vertebral body of L2 with significant dislocation and a large active bleeding of the corpus, extending to the retroperitoneum and the epidural space. Despite resuscitation, her vital signs deteriorated and given the severe abnormalities on CTA, it was decided to discontinue further treatment, after which she deceased. The performed CTA and an x-ray from 2016 suggested diffuse idiopathic skeletal hyperostosis, which might have contributed to the severity and instability of the vertebral fracture. Mobilization after the fall might have increased the dislocation of the fracture. The use of oral anticoagulants worsened the subsequent bleeding and the extension to the epidural space caused the paralysis of the legs. CONCLUSIONS It is important to be aware of the possible serious consequences of unintentional falls in the elderly population and to provide strict immobilization of the spinal column until proper imaging.
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Affiliation(s)
- Roxanne A W Ploumen
- Department of Trauma Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Martin R van Wezenbeek
- Department of Trauma Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Trauma Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Paul C P H Willems
- Department of Orthopedics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Suzanne C Gerretsen
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jan A Ten Bosch
- Department of Trauma Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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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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Hagihara S, Ohta H, Tanaka J, Shiokawa T, Kida Y, Iguchi Y, Tatsumi M, Shibata R, Tahara K, Shibata T, Sanada K, Ymamoto T. Negative Effects of Diffuse Idiopathic Skeletal Hyperostosis on Bone Fusion after Transforaminal Lumbar Interbody Fusion. Asian Spine J 2023; 17:818-825. [PMID: 37788972 PMCID: PMC10622827 DOI: 10.31616/asj.2022.0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN This study adopted a retrospective cohort study design. PURPOSE This study aimed to clarify the influence of diffuse idiopathic skeletal hyperostosis (DISH) on bone fusion after transforaminal lumbar interbody fusion (TLIF). OVERVIEW OF LITERATURE The negative effects of DISH on lumbar degenerative diseases have been reported, and DISH may be involved in the onset and severity of lumbar spinal canal stenosis. Patients with DISH have significantly more reoperations after posterior lumbar fusion, including TLIF. However, the effects of DISH on bone fusion after TLIF have not been reported. METHODS The medical records of patients with intervertebral TLIF from 2012 to 2018 were retrospectively examined. The patients were divided into those with fusion and those with pseudoarthrosis, and the following data were compared: age, sex, DISH, diabetes mellitus, smoking, drinking, albumin levels, body mass index ≥30 kg/m2, and L5/S fixation. Statistical analyses were performed using regression models. RESULTS In this study, 180 patients (78.6%) had fusion and 49 patients (21.4%) had pseudoarthrosis. The number of patients with DISH was significantly higher in the pseudoarthrosis group than in the fusion group (36.7% and 21.7%, respectively; univariate p=0.031, multivariate p =0.019). No significant differences in age, sex, diabetes mellitus, smoking, drinking, albumin levels, body mass index ≥30 kg/m2, and L5/S fixation were observed between the two groups. The risk factors for bone fusion were statistically analyzed in 57 patients with DISH. DISH with a caudal end below Th11 was an independent risk factor for pseudoarthrosis (univariate p=0.011, multivariate p=0.033). CONCLUSIONS DISH is an independent risk factor for pseudoarthrosis after one intervertebral TLIF, and DISH with a caudal end below Th11 is associated with a higher risk of pseudoarthrosis than DISH without a caudal end below Th11.
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Affiliation(s)
- Shusuke Hagihara
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | | | - Jun Tanaka
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Teruaki Shiokawa
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | | | | | | | - Ryo Shibata
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | | | - Tatsuya Shibata
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Kyoichi Sanada
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Takuaki Ymamoto
- Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
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Park J, Cho YE, Kim KH, Shin S, Kim S, Lim CH, Chung SY, Park YG. Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level. Neurospine 2023; 20:921-930. [PMID: 37798986 PMCID: PMC10562234 DOI: 10.14245/ns.2346506.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between ossification of the posterior longitudinal ligament (OPLL) size and multifidus fatty degeneration (MFD), hypothesizing that larger OPLL sizes are associated with worse MFD. METHODS One hundred four patients with cervical OPLL who underwent surgery were screened. OPLL occupying diameter and area ratios, the severity of MFD using the Goutallier classification, and range of motion (ROM) of cervical flexion-extension (ΔCobb) were measured. Correlation analyses between OPLL size, MFD severity, and ΔCobb were conducted. MFD severity was compared for each OPLL type using one-way analysis of variance. RESULTS The final clinical data from 100 patients were analyzed. The average Goutallier grade of C2-7 significantly correlated with the average OPLL diameter and area occupying ratios, and OPLL involved vertebral level (r = 0.58, p < 0.01; r = 0.40, p < 0.01; r = 0.47, p < 0.01, respectively). The OPLL size at each cervical level significantly correlated with MFD of the same or 1-3 adjacent levels. ΔCobb angle was negatively correlated with the average Goutallier grade (r = -0.31, p < 0.01) and average OPLL occupying diameter and area ratios (r = -0.31, p < 0.01; r = -0.35, p < 0.01, respectively). Patients with continuous OPLL exhibited worse MFD than those with segmental OPLL (p < 0.01). CONCLUSION OPLL size is clinically correlated with MFD and cervical ROM. OPLL at one spinal level affects MFD at the same and 1-3 adjacent spinal levels. The worsening severity of MFD is associated with the longitudinal continuity of OPLL.
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Affiliation(s)
- Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghoon Shin
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chae Hwan Lim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Young Chung
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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McCarty S, Bruckner JJ, Camacho JE, Jauregui JJ, Thomson AE, Ye I, Cavanaugh DL, Koh EY, Ludwig SC, Gelb DE. Comparison of Outcomes in Percutaneous Fixation of Traumatic Fractures between Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. Global Spine J 2023; 13:1821-1828. [PMID: 34668427 PMCID: PMC10556924 DOI: 10.1177/21925682211052003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aims to analyze outcomes and complications of patients with thoracic and lumbar fractures in the setting of ankylosing spinal disorders (ASD) treated with minimally invasive surgery (MIS). METHODS The operative logs from 2012 to 2019 from one academic, Level I trauma center were reviewed for cases of thoracic and lumbar spinal fractures in patients with ASD treated with a MIS approach. Variables were compared between patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), and advanced spondylosis. RESULTS A total of 48 patients with ASD and concomitant thoracic or lumbar spinal fracture managed with an MIS approach were identified. A total of 11 patients were identified with AS, 21 with DISH, and 16 with advanced spondylosis. A total of 27 (56.3%) patients experienced complications. Complications differed between groups; DISH patients experienced a greater number of post-operative complications compared to AS and advanced spondylosis patients (P = .009). There was no significant difference in length of surgery, estimated blood loss, length of stay, readmission, and reoperation rates between AS and DISH patients. There were 3 mortalities unrelated to the surgery. CONCLUSION Percutaneous stabilization of patients with ankylosing spinal disorder fractures remains a viable management method. Operative characteristics were similar between AS, DISH, and advanced spondylosis patients; however, DISH patients experienced a greater number of post-operative complications.
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Affiliation(s)
- Scott McCarty
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Jacob J. Bruckner
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jael E. Camacho
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexandra E. Thomson
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ivan Ye
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel L. Cavanaugh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Y. Koh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C. Ludwig
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel E. Gelb
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Hirota R, Teramoto A, Yoshimoto M, Takashima H, Yasuda N, Tsukamoto A, Iesato N, Emori M, Iba K, Kawaharada N, Yamashita T. Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2023; 12:5412. [PMID: 37629454 PMCID: PMC10455897 DOI: 10.3390/jcm12165412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH.
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Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0808, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Arihiko Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
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Zervos TM, Jago SS, Erwood MS, Basheer A, Lee IY, Lubin FD, Schultz L, Walters BC. A Multicenter Allelic Analysis of Diffuse Idiopathic Skeletal Hyperostosis: Nature Versus Nurture? Neurosurgery 2023; 93:348-357. [PMID: 36802217 PMCID: PMC10586868 DOI: 10.1227/neu.0000000000002417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/20/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is an incompletely defined disease process with no known unifying pathophysiological mechanism. OBJECTIVE To our knowledge, no genetic studies have been performed in a North American population. To summarize genetic findings from previous studies and to comprehensively test for these associations in a novel and diverse, multi-institutional population. METHODS Cross-sectional, single nucleotide polymorphism (SNP) analysis was performed in 55 of 121 enrolled patients with DISH. Baseline demographic data were available on 100 patients. Based on allele selection from previous studies and related disease conditions, sequencing was performed on COL11A2, COL6A6, fibroblast growth factor 2 gene, LEMD3, TGFB1, and TLR1 genes and compared with global haplotype rates. RESULTS Consistent with previous studies, older age (mean 71 years), male sex predominance (80%), a high frequency of type 2 diabetes (54%), and renal disease (17%) were observed. Unique findings included high rates of tobacco use (11% currently smoking, 55% former smoker), a higher predominance of cervical DISH (70%) relative to other locations (30%), and an especially high rate of type 2 diabetes in patients with DISH and ossification of the posterior longitudinal ligament (100%) relative to DISH alone (100% vs 47%, P < .001). Compared with global allele rates, we found higher rates of SNPs in 5 of 9 tested genes ( P < .05). CONCLUSION We identified 5 SNPs in patients with DISH that occurred more frequently than a global reference. We also identified novel environmental associations. We hypothesize that DISH represents a heterogeneous condition with both multiple genetic and environmental influences.
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Affiliation(s)
- Thomas M. Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Silvienne Sint Jago
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew S. Erwood
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ian Y. Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Farah D. Lubin
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, Michigan, USA
| | - Beverly C. Walters
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Zhu J, Lu Q, Zhan X, Huang S, Zhou C, Wu S, Chen T, Yao Y, Liao S, Yu C, Fan B, Yang Z, Gu W, Wang Y, Wei W, Liu C. To infer the probability of cervical ossification of the posterior longitudinal ligament and explore its impact on cervical surgery. Sci Rep 2023; 13:9816. [PMID: 37330595 PMCID: PMC10276809 DOI: 10.1038/s41598-023-36992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023] Open
Abstract
The ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is commonly observed in degenerative changes of the cervical spine. Early detection of cervical OPLL and prevention of postoperative complications are of utmost importance. We gathered data from 775 patients who underwent cervical spine surgery at the First Affiliated Hospital of Guangxi Medical University, collecting a total of 84 variables. Among these patients, 144 had cervical OPLL, while 631 did not. They were randomly divided into a training cohort and a validation cohort. Multiple machine learning (ML) methods were employed to screen the variables and ultimately develop a diagnostic model. Subsequently, we compared the postoperative outcomes of patients with positive and negative cervical OPLL. Initially, we compared the advantages and disadvantages of various ML methods. Seven variables, namely Age, Gender, OPLL, AST, UA, BMI, and CHD, exhibited significant differences and were used to construct a diagnostic nomogram model. The area under the curve (AUC) values of this model in the training and validation groups were 0.76 and 0.728, respectively. Our findings revealed that 69.2% of patients who underwent cervical OPLL surgery eventually required elective anterior surgery, in contrast to 86.8% of patients who did not have cervical OPLL. Patients with cervical OPLL had significantly longer operation times and higher postoperative drainage volumes compared to those without cervical OPLL. Interestingly, preoperative cervical OPLL patients demonstrated significant increases in mean UA, age, and BMI. Furthermore, 27.1% of patients with cervical anterior longitudinal ligament ossification (OALL) also exhibited cervical OPLL, whereas this occurrence was only observed in 6.9% of patients without cervical OALL. We developed a diagnostic model for cervical OPLL using the ML method. Our findings indicate that patients with cervical OPLL are more likely to undergo posterior cervical surgery, and they exhibit elevated UA levels, higher BMI, and increased age. The prevalence of cervical anterior longitudinal ligament ossification was also significantly higher among patients with cervical OPLL.
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Affiliation(s)
- Jichong Zhu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Qing Lu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Xinli Zhan
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Shengsheng Huang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Chenxing Zhou
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Shaofeng Wu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Tianyou Chen
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Yuanlin Yao
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Shian Liao
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Chaojie Yu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Binguang Fan
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Zhenwei Yang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Wenfei Gu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Yihan Wang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Wendi Wei
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China
| | - Chong Liu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People's Republic of China.
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Holgate R, L'Abbé EN, Steyn M. Diffuse Idiopathic Skeletal Hyperostosis (DISH): New evidence from micro-XCT scanning. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:48-55. [PMID: 36529049 DOI: 10.1016/j.ijpp.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To observe and describe the development and underlying structure of the spinal manifestations of individuals osteologically diagnosed with DISH (Diffuse Idiopathic Skeletal Hyperostosis), using micro-XCT imaging. MATERIALS A total of 72 individuals with DISH were identified in two modern skeletal collections in South Africa. METHODS Vertebral columns affected by DISH were scanned at the micro-focus x-ray computed tomography facility at the Nuclear Energy Corporation of South Africa. Four features were macroscopically examined: (1) the origin of the new bone growth; (2) retention of the original vertebral cortex at the site of the new bone formation associated with DISH; (3) evidence of trabecular bone with or without sclerosis on the anterolateral surface of affected vertebrae; and (4) abnormal areas of osteosclerosis beyond features associated with DISH. RESULTS Considerable variation across and between the four recorded features was found. Of note, 81% (n = 58) of individuals had both developed trabecular bone within the flowing new bone formation (feature 3), without retention of the original vertebral cortex (feature 2). CONCLUSIONS Possible localised erosive/inflammatory processes destroyed the original cortex of the vertebral body and resulted in the expansion of trabeculae with new bone formation. SIGNIFICANCE Micro-XCT imaging shed new light on the development of DISH, adding to literature suggesting that it could be an inflammatory disease. LIMITATIONS Clinical histories of the individuals were not known. SUGGESTIONS FOR FURTHER RESEARCH The role of chronic inflammatory disease in the development of DISH should be further explored including both the extra-spinal and spinal manifestations.
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Affiliation(s)
- Rlv Holgate
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - E N L'Abbé
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - M Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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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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A case of diffuse idiopathic hyperostosis of bone (DISH) in a patient on hemodialysis. CEN Case Rep 2022; 12:226-229. [PMID: 36401745 PMCID: PMC10151430 DOI: 10.1007/s13730-022-00755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory progressive disease resulting in ossification of the anterior longitudinal ligament of the spine and tendons. Herein, we describe a case of DISH in a patient on long-term hemodialysis. The patient was a 79-year-old man undergoing hemodialysis for chronic kidney disease due to diabetic nephropathy. He presented to the emergency department complaining of back pain after a slip and fall. Radiographs revealed bamboo spine-like findings, extending from the cervical to the lumbar spine. Computed tomography and magnetic resonance imaging revealed a compression fracture of thoracic vertebra 12, with abnormal ossification of the anterior longitudinal ligament. Inter-vertebral vertical osseous bridges were also observed at the cervical 7 and lumbar 2 vertebrae. There was no obvious spinal cord compression. Leukocytosis and C-reactive protein levels were not elevated and the human leukocyte type antigen HLA-B27 test was negative. Based on this finding, a diagnosis of DISH was made. In the absence of neurological findings, the patient was treated conservatively. Our findings show an overlap between the clinical features of DISH and those of hemodialysis patients, including older age, male sex, and diabetes.
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Hoshino Y, Hidaka N, Kato H, Koga M, Taniguchi Y, Kobayashi H, Nangaku M, Makita N, Ito N. Incidence of ossification of the spinal ligaments in acromegaly patients. Bone Rep 2022; 17:101628. [PMID: 36299702 PMCID: PMC9589022 DOI: 10.1016/j.bonr.2022.101628] [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] [Received: 07/18/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022] Open
Abstract
Some previous case reports have implied a relationship between acromegaly and ossification of the spinal ligaments. However, there have been no reports of a case series exploring the incidence of ossification of the spinal ligaments in patients with acromegaly. To this end, computed tomography (CT) of the spine in 10 consecutive patients with acromegaly was examined in this study. Five out of 10 patients had ossification of the spinal ligaments. Among them, two patients had ossification of the posterior longitudinal ligament (OPLL), which was noticeably higher than the prevalence of OPLL in the general adult population (1.9–4.3 %). Body mass index was significantly higher in the group with spinal ligament ossification (p = 0.03), but there were no significant differences in age, sex, serum phosphate, albumin-adjusted calcium, growth hormone (GH), standard deviation of insulin-like growth factor-1 (IGF-1), or the incidence of diabetes mellitus between the groups with or without ossification of the spinal ligaments. The ossification index (OS index) was used to determine the severity of spinal ligament ossification, and there were no significant correlations between the OS index and GH or IGF-1 (p = 0.51 and 0.75, respectively). This study was the first to report a high prevalence of spinal ossification in patients with acromegaly. In conclusion, this study suggested a possible association between acromegaly and ossification of the spinal ligaments, although the number of patients was insufficient to draw a conclusion. Acromegaly patients should be tested to confirm, or rule out, spinal ossification, and further studies to clarify the underlying mechanism of spinal ossification in acromegaly patients are warranted.
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Affiliation(s)
- Yoshitomo Hoshino
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Naoko Hidaka
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hajime Kato
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Minae Koga
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Noriko Makita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Nobuaki Ito
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Corresponding author at: Division of Nephrology and Endocrinology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Surgical Treatment of Dysphagia Secondary to Anterior Cervical Osteophytes Due to Diffuse Idiopathic Skeletal Hyperostosis. Medicina (B Aires) 2022; 58:medicina58070928. [PMID: 35888647 PMCID: PMC9321449 DOI: 10.3390/medicina58070928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is an ossifying and ankylosing skeletal condition that can be associated with DISH-related dysphagia in the case of cervical involvement. In contrast to most cases of dysphagia, which are managed conservatively, DISH-related dysphagia can be discouraging due to the progressive nature of DISH. We report two cases of DISH-related dysphagia that were treated with the surgical removal of osteophytes via an anterolateral approach. We were able to remove osteophytes using the bottleneck point as an anatomical landmark between the vertebral body and the bony excrescence. Patients’ symptoms improved following osteophyte removal, without recurrence. In cases of DISH-related dysphagia, osteophyte removal using an osteotome could improve dysphagia safely and quickly.
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17
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Castells Navarro L, Buckberry J. The prevalence of diffuse idiopathic skeletal hyperostosis in England and Catalonia from the Roman to the post-medieval periods. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 37:9-22. [PMID: 35279001 DOI: 10.1016/j.ijpp.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Evaluate the prevalence of DISH through time from the Roman to the post-Medieval period in England and Catalonia. MATERIAL 281 individuals from England and 247 from Catalonia were analyzed. METHODS Adult individuals with at least three well-preserved lower thoracic vertebral bodies were analyzed. DISH was assessed considering the early stages of development. Diachronic and geographical dietary shifts were investigated using reported light isotope data, archaeological reports and historical documentation. RESULTS Males and older individuals showed consistently higher prevalence of DISH, however, only the English sample showed a significant difference between males and females in the prevalence of DISH. No significant difference was found in the prevalence of DISH though time (from Roman to post medieval periods) nor across regions (England and Catalonia). CONCLUSION The development of DISH is probably influenced by a combination of factors including increasing age and sex. SIGNIFICANCE This is the first exhaustive analysis of DISH in ancient Catalan populations and the first that considers the early stages of DISH. LIMITATIONS Reduced sample size, particularly in post-medieval samples, as a result of the available excavated samples and the inclusion criteria adopted. FUTURE RESEARCH Include rural, religious and high-status samples in the analysis of DISH. Re-assess the prevalence of DISH in post-medieval populations.
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Affiliation(s)
- Laura Castells Navarro
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford BD7 1DP, UK; Archaeology Department, University of Exeter, Exeter EX4 4QJ, UK.
| | - Jo Buckberry
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford BD7 1DP, UK
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18
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Vierunen RM, Haapamäki VV, Koivikko MP, Bensch FV. Ankylosis of the cervical spine increases the incidence of blunt cerebrovascular injury (BCVI) in CTA screening after blunt trauma. Emerg Radiol 2022; 29:507-517. [PMID: 35296926 PMCID: PMC9123032 DOI: 10.1007/s10140-022-02022-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine, imaged with CT angiography (CTA) after blunt trauma. The related etiologies of ankylosis had an additional focus. MATERIALS AND METHODS Altogether of 5867 CTAs of the craniocervical arteries imaged after blunt trauma between October 2011 and March 2020 were manually reviewed for a threshold value of ankylosis of at least three consecutive cervical vertebrae. BCVI was the primary outcome and associated stroke as the secondary outcome. Variables were craniofacial and cervical spine fractures, etiology and levels of ankylosis, traumatic brain injury, spinal hematoma, spinal cord injury, and spinal cord impingement, for which correlations with BCVI were examined. RESULTS Of the 153 patients with ankylosis and blunt trauma of the cervical spine, 29 had a total of 36 BCVIs, of whom two had anterior and 4 posterior circulation strokes. Most of the BCVIs (n = 32) were in the vertebral arteries. Injuries were graded according to the Biffl scale: 17 grade II, 4 grade III, 14 grade IV, and 1 grade V. A ground-level fall was the most common trauma mechanism. Cervical spine fracture was the only statistically significant predictor for BCVI (OR 7.44). Degenerative spondylosis was the most prevalent etiology for ankylosis. CONCLUSION Ankylosis of the cervical spine increases the incidence of BCVI up to sevenfold compared to general blunt trauma populations, affecting especially the vertebral arteries.
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Affiliation(s)
- Riku M Vierunen
- Department of Radiology, Helsinki University and Helsinki University Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.
| | - Ville V Haapamäki
- Department of Radiology, Helsinki University and Helsinki University Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Mika P Koivikko
- Department of Radiology, Helsinki University and Helsinki University Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Frank V Bensch
- Department of Radiology, Helsinki University and Helsinki University Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
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Castells Navarro L, Buckberry J, Beaumont J. An isotope signature for diffuse idiopathic skeletal hyperostosis? AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 178:312-327. [PMID: 36790671 PMCID: PMC9313887 DOI: 10.1002/ajpa.24497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/09/2021] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Diffuse idiopathic skeletal hyperostosis (DISH) has recurrently been associated with a rich diet (high in protein and higher trophic level foods); however, very few studies have investigated this link using carbon and nitrogen (δ13C and δ15N) stable isotope analysis. This paper explores the relationship between DISH and diet in two Roman urban communities by analyzing individuals with and without DISH. MATERIALS AND METHODS δ13C and δ15N analysis carried out on collagen from 33 rib samples (No DISH: 27; early DISH: 4; DISH: 2) selected from individuals buried at the Romano-British site of Baldock (UK), 41 rib samples (No DISH: 38; early DISH: 3) from individuals from the Catalan Roman site of Santa Caterina (Barcelona, Spain). Additionally, six faunal samples from Baldock and seven from Santa Caterina were analyzed. RESULTS Standardized human isotope data from Santa Caterina show high δ15N probably associated to a diet combining terrestrial resources and freshwater fish. In contrast, isotope results from Baldock suggest a terrestrial-based diet. Individuals with DISH do not show isotopic ratios indicative of rich diet and there is no correlation between stage of DISH development and δ13C and δ15N. CONCLUSION The results of this study suggest that individuals with DISH followed a similar or isotopically similar diet as those individuals without DISH in Baldock and in Santa Caterina and therefore, while DISH may have been influenced by individual's dietary habits, this is not reflected in their isotopic signature.
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Affiliation(s)
- Laura Castells Navarro
- Department of ArchaeologyUniversity of ExeterExeterUK
- School of Archaeological and Forensic SciencesUniversity of BradfordBradfordUK
| | - Jo Buckberry
- School of Archaeological and Forensic SciencesUniversity of BradfordBradfordUK
| | - Julia Beaumont
- School of Archaeological and Forensic SciencesUniversity of BradfordBradfordUK
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Falsetti P, Conticini E, Baldi C, Bardelli M, Cantarini L, Frediani B. Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study. REUMATOLOGIA CLINICA 2022; 18:273-278. [PMID: 35568441 DOI: 10.1016/j.reumae.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/30/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH). METHODS Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group. RESULTS Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH. CONCLUSIONS Diffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.
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Affiliation(s)
- Paolo Falsetti
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy.
| | - Edoardo Conticini
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
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Ikuma H, Hirose T, Nakamura D, Yamashita K, Ueda M, Sasaki K, Kawasaki K. The Prevalence and Characteristics of Diffuse Idiopathic Skeletal Hyperostosis (DISH): A Cross-Sectional Study of 1519 Japanese Individuals. Diagnostics (Basel) 2022; 12:diagnostics12051088. [PMID: 35626245 PMCID: PMC9140032 DOI: 10.3390/diagnostics12051088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a pathology characterized by enthesis ossification, but there have been few reports on epidemiological surveys. This report presents a cross-sectional survey of DISH from thoracic to sacral spine in patients at the tertiary emergency medical center. Methods: The patients were divided into DISH (+) group and DISH (−) group for a retrospective comparative study. The primary outcome measures were the frequency of DISH and the patient demographic data, the secondary outcome measures were the previous medical history (diabetes mellitus, cardiovascular disease), the extent of aortic calcification, the frequency of hyperostosis around the costovertebral joint and the mortality rate within 3 months of the initial examination. Results: This survey examined a total of 1519 patients. There were 265 cases (17.4%) in the DISH (+) group and 1254 cases in DISH (−) group. The prevalence of DISH was concentrated at the thoracolumbar junction, particularly at T9. The mean age, ratio of male and hyperostosis around the costovertebral joint were significantly higher in the DISH (+) group (p < 0.001), but there was no significant difference in other variables. Conclusions: The pathology of DISH might involve the effects of age-related changes or biomechanical effects.
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Affiliation(s)
- Hisanori Ikuma
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
- Correspondence: ; Tel.: +81-87-811-3333
| | - Tomohiko Hirose
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Dai Nakamura
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Kazutaka Yamashita
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Masataka Ueda
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Kazuhiro Sasaki
- Department of Emergency and Critical Care Medicine, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan;
| | - Keisuke Kawasaki
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
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22
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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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Uemoto M, Mizumoto J. Vertebral compression fracture with diffuse idiopathic skeletal hyperostosis. J Gen Fam Med 2022; 23:118-119. [PMID: 35261862 PMCID: PMC8888803 DOI: 10.1002/jgf2.495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/13/2021] [Accepted: 08/24/2021] [Indexed: 11/09/2022] Open
Abstract
A 90-year-old Japanese man presented with back pain after falling. Imaging tests revealed compression fracture of the lumber vertebrae with diffuse idiopathic skeletal hyperostosis (DISH), and surgical intervention was performed. Back pain is common in primary care setting, and primary care physicians should recognize this condition well.
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Affiliation(s)
- Mayu Uemoto
- Department of Internal and Family MedicineTakamatsu Heiwa HospitalKagawaJapan
| | - Junki Mizumoto
- Department of Medical Education StudiesInternational Research Center for Medical EducationGraduate School of MedicineThe University of TokyoTokyoJapan
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24
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Harlianto NI, Oosterhof N, Foppen W, Hol ME, Wittenberg R, van der Veen PH, van Ginneken B, Mohamed Hoesein FAA, Verlaan JJ, de Jong PA, Westerink J. Diffuse idiopathic skeletal hyperostosis is associated with incident stroke in patients with increased cardiovascular risk. Rheumatology (Oxford) 2021; 61:2867-2874. [PMID: 34791065 PMCID: PMC9258598 DOI: 10.1093/rheumatology/keab835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/02/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Earlier retrospective studies have suggested a relation between diffuse idiopathic skeletal hyperostosis [DISH] and cardiovascular disease, including myocardial infarction. The present study assessed the association between DISH and incidence of cardiovascular events and mortality in patients with high cardiovascular risk. METHODS In this prospective cohort study, we included 4624 patients (mean age 58.4 years, 69.6% male) from the Second Manifestations of ARTerial disease cohort. The main end point was major cardiovascular events [MACE: stroke, myocardial infarction, and vascular death]. Secondary endpoints included all-cause mortality and separate vascular events. Cause specific proportional hazard models were used to evaluate the risk of DISH on all outcomes, and subdistribution hazard models were used to evaluate the effect of DISH on the cumulative incidence. All models were adjusted for age, sex, body mass index, blood pressure, diabetes, non-HDL cholesterol, packyears, renal function, and C-reactive protein. RESULTS DISH was present in 435 (9.4%) patients. After a median follow-up of 8.7 (IQR 5.0-12.0) years, 864 patients had died and 728 patients developed a MACE event. DISH was associated with an increased cumulative incidence of ischaemic stroke.After adjustment in cause specific modelling, DISH remained significantly associated with ischaemic stroke (HR 1.55; 95%CI : 1.01-2.38), but not with MACE (HR 0.99; 95%CI : 0.79-1.24), myocardial infarction (HR 0.88; 95%CI : 0.59-1.31), vascular death (HR 0.94; 95%CI : 0.68-1.27), or all-cause mortality (HR 0.94; 95%CI : 0.77-1.16). CONCLUSION The presence of DISH is independently associated with an increased incidence and risk for ischaemic stroke, but not with MACE, myocardial infarction, vascular death, or all-cause mortality.
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Affiliation(s)
- Netanja I Harlianto
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the.,Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, the Netherlands, Utrecht
| | - Nadine Oosterhof
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Marjolein E Hol
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Rianne Wittenberg
- Department of Radiology, Netherlands Cancer Institute, the Netherlands, Amsterdam
| | - Pieternella H van der Veen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Firdaus A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, the Netherlands, Utrecht
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Netherlands, Utrecht, the
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, the Netherlands, Utrecht
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Schwendner M, Seule M, Meyer B, Krieg SM. Management of spine fractures in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis: a challenge. Neurosurg Focus 2021; 51:E2. [PMID: 34598125 DOI: 10.3171/2021.7.focus21330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ankylosing spinal disorders (ASDs) such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are complex diseases regarding diagnostics, treatment, and patient outcome, especially in trauma. Originating from rigid biomechanics and low bone quality in considerably comorbid patients, serious spinal injury requires thorough and immediate imaging and is frequently missed. The aim of this study was to evaluate patient characteristics as well as procedures in patients with ASD in order to identify the major particularities of treatment. METHODS A total of 60 patients aged 78.5 ± 8.9 years were retrospectively included. Preoperative imaging as well as surgical treatment procedures and postoperative patient outcome were analyzed, including 30-day readmissions. RESULTS CT imaging of the entire spine was performed within 24 hours after the initial trauma in 73.3% of patients. A delay in diagnostics (> 24 hours) occurred in 41.7% of patients transferred from primary care centers. At admission, 25.0% of patients had fracture-related neurological deficits (American Spinal Injury Association [ASIA] grades A and B in 4 patients, and ASIA grades C and D in 11 patients). A spinal epidural hematoma was found in 21.2% of patients and was symptomatic in 72.7% of those patients. Of the patients with fracture-related neurological deficits, 93.3% were operated on within 48 hours from symptom onset. One patient (1.7%) developed neurological deficits from diagnosis to surgery. Postoperatively, 18.3% of patients had surgical complications, and 76.7% of patients developed further medical issues, with pneumonia (38.3%), pulmonary decompensation (25.0%), and cardiac decompensation (20.0%) being the leading causes. The 30-day mortality rate was high at 10.0%. CONCLUSIONS Treatment of patients with ASDs is complex. While surgical outcome is usually good, the multimorbid nature of these patients results in a high rate of major medical complications. If an ankylosing disease is suspected, MRI of the entire spine is mandatory. Upon diagnosis, treatment should be performed in centers capable of managing all aspects of the regular complications these patients will develop.
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Affiliation(s)
- Maximilian Schwendner
- 1Department of Neurosurgery and.,2TUM Neuroimaging Center, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; and
| | - Martin Seule
- 3Department of Neurosurgery, Kantonsspital St. Gallen, Switzerland
| | | | - Sandro M Krieg
- 1Department of Neurosurgery and.,2TUM Neuroimaging Center, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; and
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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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Visceral Adipose Tissue and Different Measures of Adiposity in Different Severities of Diffuse Idiopathic Skeletal Hyperostosis. J Pers Med 2021; 11:jpm11070663. [PMID: 34357130 PMCID: PMC8305748 DOI: 10.3390/jpm11070663] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is associated with both obesity and type 2 diabetes. Our objective was to investigate the relation between DISH and visceral adipose tissue (VAT) in particular, as this would support a causal role of insulin resistance and low grade inflammation in the development of DISH. Methods: In 4334 patients with manifest vascular disease, the relation between different adiposity measures and the presence of DISH was compared using z-scores via standard deviation logistic regression analyses. Analyses were stratified by sex and adjusted for age, systolic blood pressure, diabetes, non-HDL cholesterol, smoking status, and renal function. Results: DISH was present in 391 (9%) subjects. The presence of DISH was associated with markers of adiposity and had a strong relation with VAT in males (OR: 1.35; 95%CI: 1.20–1.54) and females (OR: 1.43; 95%CI: 1.06–1.93). In males with the most severe DISH (extensive ossification of seven or more vertebral bodies) the association between DISH and VAT was stronger (OR: 1.61; 95%CI: 1.31–1.98), while increased subcutaneous fat was negatively associated with DISH (OR: 0.65; 95%CI: 0.49–0.95). In females, increased subcutaneous fat was associated with the presence of DISH (OR: 1.43; 95%CI: 1.14–1.80). Conclusion: Markers of adiposity, including VAT, are strongly associated with the presence of DISH. Subcutaneous adipose tissue thickness was negatively associated with more severe cases of DISH in males, while in females, increased subcutaneous adipose tissue was associated with the presence of DISH.
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28
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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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Falsetti P, Conticini E, Baldi C, Bardelli M, Cantarini L, Frediani B. Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00032-2. [PMID: 33640321 DOI: 10.1016/j.reuma.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH). METHODS Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group. RESULTS Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH. CONCLUSIONS Diffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.
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Affiliation(s)
- Paolo Falsetti
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy.
| | - Edoardo Conticini
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, University of Siena, Santa Maria alle Scotte Hospital, Siena, Italy
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30
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Fassio A, Adami G, Idolazzi L, Giollo A, Viapiana O, Bosco E, Negrelli R, Sani E, Sandri D, Mantovani A, Targher G, Rossini M, Gatti D. Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Type 2 Diabetes: A New Imaging Possibility and a New Biomarker. Calcif Tissue Int 2021; 108:231-239. [PMID: 33047242 DOI: 10.1007/s00223-020-00768-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
We performed a cross-sectional study to investigate the prevalence of Diffuse Idiopathic Skeletal Hyperostosis (DISH) through Dual-Energy X-ray absorptiometry (DXA) Vertebral Fracture Assessment (VFA) in a group of post-menopausal women with Type 2 Diabetes Mellitus (T2DM). We also explored several biomarkers of bone turnover metabolism, including Wnt pathway modulators. DXA-VFA was performed to detect the presence of DISH. Serum samples were collected from all patients at the time of study recruitment. 16 different serum biomarkers were tested between the two subgroups. Given the exploratory nature of the study, we did not adjust for multiplicity. At VFA analysis, among 96 individuals enrolled in the study 20 (20.8%) showed features of DISH. No statistically significant difference was found for BMD values, between the DISH and NO-DISH subgroups. Concerning blood biomarkers, DISH patients showed a significant difference only in the sclerostin serum levels (32 vs 35.5 pmol/L, for the DISH and NO-DISH subgroup, respectively; p = 0.010). After adjustment for confounding factors, sclerostin serum levels remained significantly lower in DISH group (p = 0.002). We demonstrated a non-negligible prevalence of DISH in a population of post-menopausal women affected by T2DM and suggested low serum sclerostin as a possible key feature associated with DISH presence. In addition, we propose DXA-VFA analysis, whose radiation dose is considerably lower than conventional radiography, as a viable diagnostic and prognostic mean to obtain data not only on bone health, but also for the screening for DISH in subjects at risk.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy.
| | - Giovanni Adami
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | - Alessandro Giollo
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | - Emma Bosco
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | | | - Elena Sani
- Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy
| | - Damiano Sandri
- Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy
| | - Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy
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Shabani M, Pishgar F, Akhtarkhavari S, Quinaglia T, Budoff MJ, Bluemke DA, Barr GR, Post WS, Wu CO, Arbab-Zadeh A, Sidhaye A, Lima JAC, Demehri S. Association of Quantified Costal Cartilage Calcification and Long-Term Cumulative Blood Glucose Exposure: The Multi-Ethnic Study of Atherosclerosis. Front Endocrinol (Lausanne) 2021; 12:785957. [PMID: 34966360 PMCID: PMC8711271 DOI: 10.3389/fendo.2021.785957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Anecdotal reports have suggested increased soft tissue calcification in individuals with long-term exposures to high blood glucose. The association of costal cartilage calcification (CCC), a reliably quantifiable marker obtainable from non-contrast cardiac computed tomography (CT) with cumulative fasting blood glucose (FBG) exposure, is unknown. In this study, we aimed to determine the association between quantified CCC and cumulative glucose exposure using non-contrast coronary artery calcium (CAC) scoring computed tomography (CT) images in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS The volume of bilateral CCC was quantified in high-density pixels (threshold of Hounsfield Unit>180) using the CAC scoring CT images acquired in the 5th MESA exam. Prior long-term cumulative exposure to FBG was calculated by area under the FBG-time curve over ten years before the time of the CT exam. RESULTS A total of 2,305 participants (mean age: 69, female/male: 1.3) were included in this study. The median CCC volume was lower in females than males (1158 mm3 [IQR: 1751] vs. 3054 mm3 [3851], p<0.001). In cross-sectional analysis, quantified CCC was associated with FBG (9% increase per SD) and HbA1c (7% increase per SD) at the CT exam only in female participants after adjustment for age, race, BMI, and glomerular filtration rate. Only in female participants, quantified CCC was also associated with prior cumulative FBG (3% increase per decile change). In the subgroup of females with zero CAC scores, the adjusted CCC was still associated with FBG (13% increase per SD) at the time of CT exam and with prior cumulative FBG exposure (4% increase per decile change) before the CT exam. CONCLUSIONS The CCC, a reliably quantified marker in non-contrast cardiac CT, is associated with 10-year cumulative FBG exposure only in female participants, even those with zero CAC.
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Affiliation(s)
- Mahsima Shabani
- Department of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Farhad Pishgar
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sepehr Akhtarkhavari
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Thiago Quinaglia
- Department of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Matthew J. Budoff
- Lundquist Institute, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Graham R. Barr
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Wendy S. Post
- Department of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Armin Arbab-Zadeh
- Department of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aniket Sidhaye
- Department of Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - João A. C. Lima
- Department of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Shadpour Demehri
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Shadpour Demehri,
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Watanabe D, Takano H, Kimura T, Yamashita A, Minowa T, Mizushima A. The relationship of diffuse idiopathic skeletal hyperostosis, visceral fat accumulation, and other age-related diseases with the prevalent vertebral fractures in elderly men with castration-naïve prostate cancer. Aging Male 2020; 23:1512-1517. [PMID: 33191830 DOI: 10.1080/13685538.2020.1815694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in prostate cancer patients and its relationship with prevalent vertebral fractures (PVF) has not yet been demonstrated. This study aimed to investigate the relationship of DISH, visceral fat accumulation, and other age-related diseases to PVF in elderly men with castration-naïve prostate cancer (CNPC). A total of 134 CNPC patients who were ≥65 years of age without bone metastases were registered in this study. DISH was found in 36.6% (49/134) of the patients in the study population. Patients with DISH were significantly older and had a lower total hip-bone mineral density (BMD) than those without DISH. On the other hand, there were no significant differences in fat distribution, prevalence of hypertension, dyslipidemia, diabetes, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c, prostate-specific antigen (PSA), or lumbar-BMD (L-BMD). A multivariate analysis of age, DISH, body mass index (BMI), visceral fat area (VFA), and total hip-BMD, which were significantly associated with PVF in a univariate analysis, showed that age (OR 1.11; p = .02) and DISH (OR 5.99; p = .0003) were independently associated with PVF. This study suggests that the presence of DISH may not be negligible when assessing the risk of vertebral fracture in prostate cancer patients before treatment.
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Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Koto Hospital, Tokyo, Japan
| | - Hiromitsu Takano
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Doi T, Sakamoto R, Horii C, Okamoto N, Nakajima K, Hirai S, Oguchi F, Kato S, Taniguchi Y, Matsubayashi Y, Hayashi N, Tanaka S, Oshima Y. Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects. J Neurosurg Spine 2020; 33:316-322. [PMID: 32384273 DOI: 10.3171/2020.3.spine2082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence and risk factors for the progression of ossification of the posterior longitudinal ligament (OPLL) have been previously reported in surgically and nonsurgically treated symptomatic patients. However, the correlates of OPLL progression in asymptomatic subjects with OPLL are not well characterized. This study aimed to clarify the incidence and risk factors for OPLL progression in asymptomatic subjects based on whole-body CT. METHODS The authors retrospectively reviewed 2585 healthy subjects who underwent whole-body CT at a single health center from September 2007 to December 2011. This study included asymptomatic subjects with OPLL who underwent CT scans twice with an interval of at least 5 years. Progression of OPLL was assessed based on initial and final CT scan. Subjects were divided into two groups: nonprogression (OPLL-NP) and progression (OPLL-P) groups. Clinical characteristics, bone mineral density status, OPLL types, and OPLL involvement of multiple vertebral levels between the two groups were compared. Risk factors for progression of OPLL were identified by logistic regression analysis after propensity score adjustment. RESULTS Of the 109 subjects with OPLL (91 men and 18 women), 20 (18.3%) exhibited OPLL progression (OPLL-P group). Subjects in the OPLL-P group were significantly younger (p = 0.031), had higher prevalence of multilevel OPLL involvement (p = 0.041) and continuous type of OPLL (p = 0.015), and had higher uric acid (UA) levels (p = 0.004) at the time of initial CT examination compared to the OPLL-NP group. Younger age (adjusted odds ratio [aOR] 0.95, 95% CI 0.90-0.99), OPLL involvement of multiple vertebral levels (aOR 2.88, 95% CI 1.06-7.83), continuous type of OPLL (aOR 4.21, 95% CI 1.35-13.10), and higher UA levels (aOR 2.09, 95% CI 1.24-3.53) were significant risk factors for OPLL progression. CONCLUSIONS Younger age, OPLL involvement of multiple vertebral levels, continuous type of OPLL, and higher UA levels are significant risk factors for OPLL progression in asymptomatic subjects.
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Affiliation(s)
- Toru Doi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Ryuji Sakamoto
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Chiaki Horii
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Naoki Okamoto
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Koji Nakajima
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Shima Hirai
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Fumihiko Oguchi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - So Kato
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Yuki Taniguchi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | | | - Naoto Hayashi
- 2Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Sakae Tanaka
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Yasushi Oshima
- 1Department of Orthopaedic Surgery, University of Tokyo; and
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Glick K, Novofastovski I, Schwartz N, Mader R. Cardiovascular disease in diffuse idiopathic skeletal hyperostosis (DISH): from theory to reality-a 10-year follow-up study. Arthritis Res Ther 2020; 22:190. [PMID: 32807215 PMCID: PMC7430040 DOI: 10.1186/s13075-020-02278-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Objective To describe actual cardiovascular events over a decade in patients with diffuse idiopathic skeletal hyperostosis (DISH), without previously known CV diseases. Methods The medical records of patients with DISH and controls, beginning in 2006 (without known CV disease), were reviewed. Demographic, constitutional, and laboratory data were collected. Comparison of CV events following 2006 was performed according to the outcome definitions set by the Framingham score 2: coronary event demonstrated by a coronary imaging modality, acute myocardial infarction (MI), coronary death, congestive heart failure with a reduced ejection fraction, and angina pectoris. Results Data were available for 45 patients with DISH and 47 controls without DISH from the original cohort (91.8% and 97.9% respectively). By the Framingham score, 28.6% (± 20.33) of the DISH patients were expected to be affected with CVD at 10 years of follow-up. We observed that nearly 39% of them developed CVD during that period (95% CI 23.8–53.5%). The incidence of MI over the 10-year period was significantly higher in the DISH group (P = 0.005). The DISH group had higher morbidity with a higher composite outcome of 38.8% vs 25.5% in the control cohort, and the number of non-elective hospital admissions per patient, despite neither reaching statistical significance. Conclusion Our study showed that the Framingham score underestimates the real risk for developing CVD in patients with DISH, specifically the risk for MI. We propose more scrutiny is warranted in evaluating CV risk in these patients, more demanding treatment target goals should be established, and earlier and more aggressive medical interventions should be undertaken, particularly primary prevention. Larger prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Karina Glick
- Department of Medicine A, Assuta University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | | | | | - Reuven Mader
- Rheumatic Diseases Unit, Ha'Emek MC, 18101, Afula, Israel.
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Bieber A, Masala IF, Mader R, Atzeni F. Differences between diffuse idiopathic skeletal hyperostosis and spondyloarthritis. Immunotherapy 2020; 12:749-756. [DOI: 10.2217/imt-2020-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal syndrome that has been known for more than 70 years. Yet, its pathogenesis and treatment options are still under investigation. DISH and spondyloarthritidies may manifest itself clinically as very similar disorders causing impaired axial flexibility, axial pain and peripheral tendinopathies. On the other hand, these two processes are different in many ways, from different genetic and metabolic predispositions, to different clinical and imaging manifestations, and at last, a different attitude toward treatment. The knowledge of the similarities and differences between DISH and spondyloarthritidies can guide the clinician toward a better diagnostic and treatment approach. This review tries to emphasize these details.
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Affiliation(s)
- Amir Bieber
- Rheumatic diseases Unit, Ha'Emek MC, Afula, Israel
| | | | - Reuven Mader
- Rheumatic diseases Unit, Ha'Emek MC, Afula, Israel
| | - Fabiola Atzeni
- Trauma & Orthopedic Unit, Santissima Trinità Hospital, Cagliari, Italy
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
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Xu M, Liu Y, Yang J, Liu H, Ding C. Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature. BMC Anesthesiol 2020; 20:161. [PMID: 32605592 PMCID: PMC7325286 DOI: 10.1186/s12871-020-01077-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Ossification of the anterior longitudinal ligament (OALL) of the cervical spine is a common, but rarely symptomatic, condition mostly observed in the geriatric population. Although the condition usually requires no intervention, it could lead to a difficult airway and compromise the patient’s safety. Case presentation Here, we describe the case of a 50-year-old man with cervical myelopathy and OALL that resulted in difficult endotracheal intubation after induction of anesthesia. Radiography and magnetic resonance imaging findings showed OALL, with prominent osteophytes involving four cervical vertebrae, a bulge in the posterior pharyngeal wall, and a narrow pharyngeal space. Airtraq® laryngoscope-assisted intubation was accomplished with rapid induction under sevoflurane-inhaled anesthesia. Conclusion Anesthesiologists should understand that OALL of the cervical spine could cause a difficult airway. However, it is difficult to recognize asymptomatic OALL on the basis of routine airway evaluation guidelines. For susceptible populations, a thorough evaluation of the airway, based on imaging studies and a history of compression symptoms, should be considered whenever possible. In case of unanticipated difficult intubation, anesthesiologists should refer to guidelines for unanticipated difficult airway management and identify OALL of the cervical spine as the cause.
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Affiliation(s)
- Min Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guo Xue Ave, Chengdu, Sichuan, 610041, PR China
| | - Yue Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guo Xue Ave, Chengdu, Sichuan, 610041, PR China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guo Xue Ave, Chengdu, Sichuan, 610041, PR China.
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guo Xue Ave, Chengdu, Sichuan, 610041, PR China
| | - Chen Ding
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guo Xue Ave, Chengdu, Sichuan, 610041, PR China
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Kato S, Terada N, Niwa O. Activities of Daily Living after Surgical Treatment for Osteoporotic Vertebral Fracture with or without Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Single-Institutional Study. Asian Spine J 2020; 14:847-856. [PMID: 32460468 PMCID: PMC7788374 DOI: 10.31616/asj.2019.0372] [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] [Received: 12/04/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Study Design This investigation was a retrospective observational study. Purpose The aim of this study was to evaluate whether having diffuse idiopathic skeletal hyperostosis (DISH) as a comorbidity affects the patient’s ability to perform activities of daily living (ADL) after surgical treatment for osteoporotic vertebral fracture (OVF). Overview of Literature A few studies have extensively evaluated elderly patients with comorbidities such as DISH and OVF-induced persistent back pain and their ability to perform ADL postoperatively. Methods In this study, 63 patients (21 men and 42 women) who underwent surgical treatment for OVF were enrolled. Of these patients, 26 had DISH (D+) and 37 did not have DISH (D-). Patient demographic characteristics and surgical, clinical, and radiological findings were compared between those with and without DISH. The change in their ability to perform ADL after surgery was also evaluated. Results Age, number of comorbidities, and 1-year mortality rate were significantly higher in the D+ group (p<0.05). Postoperative Visual Analog Scale (VAS) scores were significantly higher in patients with impaired (n=6, p=0.04) abilities to perform ADL, and improvements in VAS scores were significantly higher in patients with unchanged abilities to perform ADL (n=54, p=0.03) after surgery. The average postoperative VAS scores were 2.2 for the D+ group and 2.3 for the D- group, which were not significantly different. Conclusions The frequency of OVF with DISH was higher in elderly men with multiple comorbidities and contributed to a higher 1-year mortality rate than those in patients without DISH. However, preoperative and postoperative VAS scores and improvements in VAS scores were similar between those with and without DISH. Postoperative impaired ability to perform ADL was associated with old age, high postoperative VAS scores, and little improvements in VAS scores, which were limitedly influenced by DISH. Surgical treatment of OVF combined with DISH is effective and appropriate for elderly patients.
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Affiliation(s)
- Shinichi Kato
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Nobuki Terada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Osamu Niwa
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
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Kuperus JS, Mohamed Hoesein FAA, de Jong PA, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis: Etiology and clinical relevance. Best Pract Res Clin Rheumatol 2020; 34:101527. [PMID: 32456997 DOI: 10.1016/j.berh.2020.101527] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic bone-forming condition characterized by the presence of at least three bony bridges at the anterolateral spine. The aim of this review was to address the present state of pathophysiological knowledge, the clinical relevance, and diagnosis of DISH. The pathogenesis of DISH is currently unknown. The presence of DISH has been associated with older age, male sex, obesity, hypertension, atherosclerosis, and diabetes mellitus. Because the new bone forms mainly at entheseal sites, local fibroblasts, chondrocytes, collagen fibers, and calcified matrix are probably influenced by genetic, vascular, metabolic, and mechanical factors. Diagnosing the presence of DISH is of clinical importance, because the risk of a spinal fracture increases and associations with the metabolic syndrome, coronary and aortic disease, and respiratory effects are strong. Unravelling the pathogenesis of DISH can impact the field of regenerative medicine and bone tissue regeneration.
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Affiliation(s)
- Jonneke S Kuperus
- Department of Orthopedics, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands.
| | - Firdaus A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
| | - Jorrit Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands
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Ruetten S, Baraliakos X, Godolias G, Komp M. Surgical treatment of anterior cervical osteophytes causing dysphagia. J Orthop Surg (Hong Kong) 2020; 27:2309499019837424. [PMID: 30909798 DOI: 10.1177/2309499019837424] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Dysphagia due to anterior cervical osteophytes is a rare condition. However, it can become serious enough to permanently impair the quality of life up to making normal food intake impossible. If conservative treatment fails, there is the option of surgical resection of the osteophytes. The objective of this study was to assess the outcomes of resections of anterior cervical osteophytes causing spondylogenic dysphagia, taking literature into consideration. METHOD Resection of anterior cervical osteophytes using a standard anterior approach was performed in 14 consecutive patients with spondylogenic dysphagia between 2009 and 2015. Indomethacin or radiation was used to prevent recurrence. Imaging and clinical data were collected in follow-up examinations over an average of 50 months. RESULTS The osteophytes were sufficiently resected in all cases. Anterior plates were placed in three patients due to pronounced segmental mobility. Five patients were given recurrence prevention in the form of indomethacin, nine with radiation. One patient required revision surgery for a hematoma. No other serious complications were observed. All patients had significant improvement of their symptoms. No recurrences or signs of increasing instability were found during the follow-up period. CONCLUSION When conservative treatment fails, surgical resection of cervical osteophytes is a sufficient method for treating spondylogenic dysphagia. High patient satisfaction and improvement of the quality of life are achieved with a low complication rate. Routine additional stabilization has been discussed as recurrence prevention. Prophylaxis using indomethacin or radiation, known primarily from hip replacement, also appears to be an option.
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Affiliation(s)
- Sebastian Ruetten
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Xenophon Baraliakos
- 2 Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Bochum, Germany
| | - Georgios Godolias
- 3 Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Martin Komp
- 4 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group - Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University of Witten/Herdecke, Herne, Germany
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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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Adel H, Khan SA, Adil SO, Huda F, Khanzada U, Manohar M, Masood K. CT-Based Evaluation of Diffuse Idiopathic Skeletal Hyperostosis in Adult Population; Prevalence, Associations and Interobserver Agreement. J Clin Densitom 2020; 23:44-52. [PMID: 30583921 DOI: 10.1016/j.jocd.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH), being an asymptomatic condition, is generally discovered incidentally on imaging and it has not received much attention for research on clinical grounds. We assessed the prevalence of DISH, its associated factors, and interobserver agreement for computed tomography (CT)-based diagnosis of DISH. CT scans of chest, abdomen, and pelvis performed for various clinical indications were retrospectively reviewed. Resnick criteria were used for the diagnosis of DISH. Moreover, enthesopathy along with comorbidities was assessed. CT scans were observed by 3 observers having different experience levels. Out of total 416 patients, the prevalence of DISH was 30.8%. Strong positive agreement was observed between observer 1 and 2 (k = 0.89), observer 1 and 3 (k = 0.91), and observer 2 and 3 (k = 0.94). Reporting rate of DISH was 59.3%. Regression analyses showed that enthesopathy was 2.45 times (adjusted odds ratio [AOR]: 2.45, 95% confidence intervals [CI]: 1.48-4.05), diabetic patients were 4.74 times (AOR: 4.74, 95% CI: 2.89-7.78) while hypertensive patients were 2.17 times (AOR: 2.17, 95% CI: 1.30-3.62) more likely to have DISH in comparison to those who do not have DISH. A high prevalence of DISH was observed in our cohort. Enthesopathy and comorbidities like diabetes and hypertension were significant factors associated with DISH. Moreover, excellent agreement was observed in defining DISH on CT according to Resnick criteria.
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Affiliation(s)
- Hatem Adel
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohail Ahmed Khan
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Omair Adil
- Department of Research, Dow University of Health Sciences, Karachi, Pakistan.
| | - Farheen Huda
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Usman Khanzada
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Murli Manohar
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Kamran Masood
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
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Cox ER, Coombes JS, Keating SE, Burton NW, Coombes BK. Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation. Curr Diabetes Rev 2020; 16:211-219. [PMID: 31146662 DOI: 10.2174/1573399815666190531083504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings. METHODS A narrative review. RESULTS There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain. DISCUSSION Recommendations for future research are provided.
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Affiliation(s)
- Emily R Cox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Brooke K Coombes
- School of Allied Health Sciences, Griffith University, Nathan, Queensland, Australia
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Kato S, Terada N, Niwa O. Surgical Treatment of Osteoporotic Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis along with Comparative Assessment of the Levels of Affected Vertebra or Anterior Column Reconstruction. Spine Surg Relat Res 2019; 4:57-63. [PMID: 32039298 PMCID: PMC7002056 DOI: 10.22603/ssrr.2019-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Surgical treatment of osteoporotic vertebral fracture (OVF) often involves older patients with various comorbidities; thus, attending physicians must pay special attention to the invasiveness of surgical procedures and possible perioperative complications. In this retrospective observational study, we investigated the relationship between OVF and diffuse idiopathic skeletal hyperostosis (DISH) by examining the clinical characteristics and surgical outcomes. Methods Subjects comprised 26 patients (14 men, 12 women) who underwent surgical treatment for OVF complicated by DISH. Vertebral injuries affected the thoracolumbar transitional vertebrae in 18 patients and the middle and lower lumbar vertebrae in eight patients. The clinical characteristics, surgical results, radiological assessments, and outcomes were evaluated on the basis of the levels of affected vertebrae and whether anterior column reconstruction (ACR) was performed. Results Visual Analog Scale (VAS) measurements improved from an average of 69.7 mm before surgery to 21.3 mm after surgery. 14 patients had neurological deficits, who exhibited improvements by one or more steps on the Frankel scale after surgery. Activities of daily living (ADLs) were maintained during the six-month period following surgery in 23 patients. Comorbidity was observed in 22 patients. 14 patients had perioperative complications, and six required additional surgery. Both operating time and blood loss volume were significantly higher in patients in the middle and lower lumbar vertebrae and ACR groups. Postoperative correction loss was also significantly lower in the ACR group. Conclusions Favorable degrees of improvement in neurological deficits and VAS were observed following surgery in patients with OVF complicated by DISH, and postoperative ADLs were maintained in 92% of the patients. Elderly men frequently presented with comorbidities, and the frequencies of patients with perioperative complications and those requiring additional surgery were high.
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Affiliation(s)
- Shinichi Kato
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Nobuki Terada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Osamu Niwa
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
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Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To investigate the prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in vertebral fracture patients admitted to our hospital. SUMMARY OF BACKGROUND DATA Although vertebral fracture is generally treated conservatively with rest and use of a corset, surgery with rigid internal fixation is recommended for vertebral fractures in patients with DISH. Thus, treatment strategies for vertebral fracture differ according to the presence or absence of DISH. However, only a few studies have investigated the prevalence of DISH in vertebral fracture patients. METHODS A total of 159 patients (49 men and 110 women, with a mean age of 82.9 years) who were diagnosed with fresh vertebral fracture and required admission to HITO Hospital. The diagnosis of fresh vertebral fracture was made using x-ray imaging, computed tomography, and magnetic resonance imaging, and the presence or absence of DISH was assessed. In addition, age, sex, bone mineral density ( % young adult mean), blood test results, treatment, and length of hospital stay were compared between patients with and without DISH. RESULTS The proportion of patients with DISH among the patients with vertebral fracture was 33.9% (54 of 159 patients). The proportions in men and women were 38.8% and 31.8%, respectively, with no significant difference between sexes (P = 0.39). The patients in the DISH group were older than those in the non-DISH group (83.6 vs. 79.4 years, P = 0.009), and the DISH group had higher glycated hemoglobin A1c (P = 0.005), higher bone mineral density (P = 0.042), and longer length of hospital stay (P = 0.0001) compared with those in the non-DISH group. CONCLUSION The proportion of patients with DISH among the vertebral fracture patients was 33.9%. Given that patients with DISH may require different treatment approaches, careful observation is needed. LEVEL OF EVIDENCE 3.
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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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Mithani K, Meng Y, Pinilla D, Thani N, Tung K, Leung R, Ginsberg HJ. Diffuse idiopathic skeletal hyperostosis masquerading as asthma: case report. J Neurosurg Spine 2019; 31:261-264. [PMID: 31026818 DOI: 10.3171/2019.2.spine181291] [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: 10/28/2018] [Accepted: 02/13/2019] [Indexed: 11/06/2022]
Abstract
A 52-year-old man with a 10-year history of treatment-resistant asthma presented with repeated exacerbations over the course of 10 months. His symptoms were not responsive to salbutamol or inhaled corticosteroid agents, and he developed avascular necrosis of his left hip as a result of prolonged steroid therapy. Physical examination and radiography revealed signs consistent with diffuse idiopathic skeletal hyperostosis (DISH), including a C7-T1 osteophyte causing severe tracheal compression. The patient underwent C6-T1 anterior discectomy and fusion, and the compressive osteophyte was removed, which completely resolved his "asthma." Postoperative pulmonary function tests showed normalization of his FEV1/FVC ratio, and there was no airway reactivity on methacholine challenge. DISH is a systemic, noninflammatory condition characterized by ossification of spinal entheses, and it can present with respiratory disturbances due to airway compression by anterior cervical osteophytes. The authors present, to the best of their knowledge, the first documented case of asthma as a presentation of DISH.
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Affiliation(s)
| | | | | | | | | | - Richard Leung
- 2Respirology, St. Michael's Hospital, Toronto, Ontario, Canada
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Oudkerk SF, Mohamed Hoesein FAA, PThM Mali W, Öner FC, Verlaan JJ, de Jong PA, Kinney GL, Hokanson J, Lynch D, Silverman EK, Budoff MJ, Regan EA. Subjects with diffuse idiopathic skeletal hyperostosis have an increased burden of coronary artery disease: An evaluation in the COPDGene cohort. Atherosclerosis 2019; 287:24-29. [PMID: 31181416 PMCID: PMC8041152 DOI: 10.1016/j.atherosclerosis.2019.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding on medical imaging and often thought to be benign. Our objective was to investigate whether DISH is associated with coronary artery disease as measured with the coronary artery calcification (CAC) score in a large cohort of current and former smokers. METHODS In a subset of subjects from the COPDGene study, DISH was scored by a minimum of two independent readers if there were four adjacent levels of flowing osteophytes and a third reader adjudicated discrepancies. CAC was calculated using a modified Agatston method. Associations of DISH with the presence and extent of CAC were analyzed with and without adjustment for COPD and known atherosclerotic risk factors, including age, sex, race, diabetes, hypertension, high cholesterol, body mass index and smoking. RESULTS DISH was present in 361 subjects (13.2%) from a total group of 2728. Median (interquartile range) Agatston was 81 (0-329) in DISH subjects compared to 0 (0-94 in subjects without DISH (p < 0.001). DISH prevalence was 8.8% in CAC = 0, 12.8% in CAC1-100, 20.0% in CAC100-400 and 24.7% in CAC.400. Subjects with DISH had a significantly higher risk of having coronary artery calcifications; OR [CI95%] 1.37[1.05-1.78] (p=0.019) after correction for age, gender, race, COPD and atherosclerotic risk factors. CONCLUSIONS Subjects with DISH, a common musculoskeletal disorder involving bone formation anterior to the spine, have an increased burden of coronary artery disease, and therefore DISH may be a more relevant incidental finding than commonly thought.
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Affiliation(s)
- Sytse F Oudkerk
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands
| | - Firdaus A A Mohamed Hoesein
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands
| | - Willem PThM Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands
| | - F Cumhur Öner
- University Medical Center Utrecht, Department of Orthopedics, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- University Medical Center Utrecht, Department of Orthopedics, Utrecht, the Netherlands
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands.
| | - Gregory L Kinney
- Colorado School of Public Health, University of Colorado Denver, Department of Epidemiology, Denver, CO, USA
| | - John Hokanson
- Colorado School of Public Health, University of Colorado Denver, Department of Epidemiology, Denver, CO, USA
| | - David Lynch
- National Jewish Health, Denver CO, Department of Radiology, Division of Oncology, Cancer Center, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
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Ankylosing Spinal Disease—Diagnosis and Treatment of Spine Fractures. World Neurosurg 2019; 123:e162-e170. [DOI: 10.1016/j.wneu.2018.11.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/22/2022]
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Mori K, Yayama T, Nishizawa K, Nakamura A, Mimura T, Imai S. Aortic pulsation prevents the development of ossification of anterior longitudinal ligament toward the aorta in patients with diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: Results of chest CT-based cross-sectional study. J Orthop Sci 2019; 24:30-34. [PMID: 30232028 DOI: 10.1016/j.jos.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/07/2018] [Accepted: 08/15/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The development and etiology of diffuse idiopathic skeletal hyperostosis (DISH) were far from complete understanding. Even the precise mechanism of the development of its typical right-sided ossification of the anterior longitudinal ligament (OALL) frequently compared to 'flowing candle wax', a hallmark of DISH, remains unknown. METHODS The participants of this study were 261 individuals (31 females and 230 males) diagnosed as DISH according to the criteria established by Resnick and Niwayama extracted from a consecutive 3013 patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years old were excluded. Chest CT data were converted to the condition suitable for bone evaluation by the software application. The positional relationship between thoracic aorta and OALL, the morphology of the OALL adjacent to the aorta and the presence of calcification of the aortic wall adjacent to the OALL were studied. RESULTS Of 261 individuals with DISH, we found that thoracic aorta was localized adjacent to the OALL (AD-group) in 123 cases (47%), whereas 138 cases (53%) were not (NAD-group). All OALL in AD-group was localized between T6 and T12. The shape of the OALL adjacent to the aorta was either flat or concave except for one. No case showed obvious calcification of the aortic wall adjacent to the OALL in AD-group. CONCLUSIONS The aortic pulsation might play an important role in inhibit the development of the OALL toward the aorta in DISH. It is likely that establishment of the optimal condition of the pulsation stress simulating aortic pulsation and its delivery system can achieve arresting, slowing the progression and/or changing the morphology of the ossified lesions.
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Affiliation(s)
- Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.
| | - Takafumi Yayama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Kazuya Nishizawa
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Akira Nakamura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Tomohiro Mimura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
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Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Cohort Study from Sweden and Japan. Spine (Phila Pa 1976) 2018; 43:E1474-E1478. [PMID: 29916957 DOI: 10.1097/brs.0000000000002752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We retrospectively reviewed computed tomography (CT) records of patients in Japan and Sweden, which are both aging populations. OBJECTIVE To research the influence of ethnicity and region on diffuse idiopathic skeletal hyperostosis (DISH) prevalence. SUMMARY OF BACKGROUND DATA DISH can complicate non-surgical treatment of spinal fractures and often requires surgical intervention. We previously reported a prevalence of DISH in Japan that was higher than that reported in other studies. METHODS We retrospectively reviewed CT records of patients in Japan and Sweden, which have both aging populations. Patients undergoing whole body CT during trauma examinations at an acute outpatient clinic in Uppsala University Hospital in a 1-year period were eligible for inclusion. Excluded were those less than 40 and more than or equal to 90 years old, and those with previous spinal surgery. The prevalence of DISH by sex and age was determined according to radiographic criteria by Resnick. Results from Sweden were compared with the Japan data, which we previously reported. RESULTS Age of the eligible subjects (265 men and 153 women) ranged from 40 to 89 years, with a mean age of 63.4 years. Among men, 86 (32.5%) were diagnosed with DISH, and the results by age (40s, 50s, 60s, 70s, and 80s) were: 6 (10.7%), 13 (22%), 35 (46.1%), 17 (34%), and 15 (62.5%) patients, respectively. Among women, 16 (10.5%) had DISH, and the results by age were as follows: 1 (2.6%), 1 (3.3%), 2 (6.7%), 6 (22.2%), and 6 (22.2%) patients, respectively. These results did not differ from those previously published for Japan (Fisher exact test, men: P = 1, 0.27, 0.12, 0.06, and 1, respectively; women: P = 0.49, 0.62, 0.5, 0.8, and 0.3, respectively). CONCLUSION The presented cohort study revealed that ethnicity and region may not be notable factors of DISH prevalence, since patients from both Japan and Sweden had similar DISH prevalence. LEVEL OF EVIDENCE 3.
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