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Sul JH, Yang J, Kim TW. Intraoperative Traction May Induce Acute Onset Dysphagia With Diffuse Idiopathic Skeletal Hyperostosis After Anterior Cervical Discectomy. Korean J Neurotrauma 2022; 18:126-131. [PMID: 35557636 PMCID: PMC9064748 DOI: 10.13004/kjnt.2022.18.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jung Hoon Sul
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Joochul Yang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Littlejohn GO. Historical bioarcheological aspects of diffuse idiopathic skeletal hyperostosis in humans. Semin Arthritis Rheum 2021; 52:151942. [PMID: 34998578 DOI: 10.1016/j.semarthrit.2021.12.010] [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: 10/05/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify diffuse idiopathic skeletal hyperostosis (DISH) in the human bioarcheological record to seek out temporal, geographic and dietary information to enhance better understanding of this common condition. MATERIALS AND METHODS A review of available literature was conducted. RESULTS DISH has been identified in hominin populations over millions of years, including several different human species. The distribution of DISH in ancient populations is diverse, both temporally and geographically. Where available, dietary intake of subjects with DISH, in contrast to those without DISH, suggests that metabolic factors associate with DISH. CONCLUSION DISH is a ubiquitous human disorder over the ages. Metabolic factors appear important in ancient populations of those with DISH.
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Affiliation(s)
- Geoffrey O Littlejohn
- Emeritus Director Monash Health Rheumatology, Adjunct Clinical Professor, Monash University, Melbourne, Victoria, Australia.
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Zamora AC, Tallman SD. The role of diffuse idiopathic skeletal hyperostosis (DISH) in positive identification. J Forensic Sci 2021; 67:877-888. [DOI: 10.1111/1556-4029.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alyssa C. Zamora
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
| | - Sean D. Tallman
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
- Department of Anthropology Boston University Boston USA
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Diffuse Idiopathic Skeletal Hyperostosis of the Spine: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2021; 29:1044-1051. [PMID: 34559699 DOI: 10.5435/jaaos-d-20-01344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is an ankylosing condition affecting up to 32.5% of the general cohort. Although often asymptomatic, affected individuals may present with back pain, stiffness, dysphagia, functional decline, and neurologic deficits. Radiographically, DISH is characterized by flowing ossifications along the anterior spine spanning ≥4 vertebral bodies. Although the etiology of DISH remains unknown, diabetes mellitus and other metabolic derangements are strongly associated with DISH. Importantly, spinal ankylosis in DISH predisposes patients to unstable spine fractures from low-energy trauma, and careful consideration must be taken in managing these patients. This article reviews the epidemiology and pathophysiology of DISH, and its clinical findings, diagnostic criteria, and management.
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Harlianto NI, Mohamed Hoesein FA, de Jong PA, Verlaan JJ, Westerink J. Pseudohypoparathyroidism mimicking cervical diffuse idiopathic skeletal hyperostosis with dysphagia: A case report and literature review. Bone Rep 2021; 15:101111. [PMID: 34381851 PMCID: PMC8339251 DOI: 10.1016/j.bonr.2021.101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022] Open
Abstract
Dysphagia due to extensive ossification at anterior segments of the cervical spine is a rare occurrence and is usually attributable to diffuse idiopathic skeletal hyperostosis (DISH). We present the case of a 74-year-old female with dysphagia most likely due to ossification in pseudohypoparathyroidism type 1a (PHP1a). PHP1a is a rare, autosomal dominant disorder caused by mutations in the GNAS1 gene. Our patient had characteristic phenotype features of PHP1a, also known as Albright's hereditary osteodystrophy (AHO), which was diagnosed without genetic confirmation. She was conservatively treated with dietary measures and observation, and reported persisting symptoms of dysphagia at six-month follow-up. This is the first case to describe dysphagia in PHP1a with a similar presentation to DISH.
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Affiliation(s)
- Netanja I. Harlianto
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Pim A. de Jong
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
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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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Yoshihara H, Nadarajah V, Horowitz E. Prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis in 3299 black patients. Sci Rep 2021; 11:22181. [PMID: 34772962 PMCID: PMC8590013 DOI: 10.1038/s41598-021-01092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to examine the prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis (T-DISH) in the Black patients using the computed tomography (CT) analysis. This study is a cross-sectional study. All patients who underwent chest CT for the trauma screening and whose race was categorized as “Black” on the questionnaire were recruited in the study from Mar 2019 to Mar 2020. Demographic data, including age, sex, body mass index (BMI), and presence of diabetes mellitus (DM), were recorded. A total of 3299 Black patients (1507 women and 1792 men) were included for the analysis. The prevalence of T-DISH was 7.7% (255 patients), with 8.6% for females and 7.0% for males. The highest prevalence was observed in patients at the age of 70 years (11.7%), followed by the age of 80 years (10.5%). The highest prevalence level of T-DISH segment was at T8, followed by T9, and T7. The most frequent number of contiguous vertebrae was seven (21%). BMI was not associated with T-DISH. The presence of DM was significantly higher in male patients with T-DISH than those without T-DISH (P = 0.02).
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Affiliation(s)
- Hiroyuki Yoshihara
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Evan Horowitz
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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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: 2] [Impact Index Per Article: 0.7] [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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Fallah H, Rademaker M. Isotretinoin for acne vulgaris - an update on adverse effects and laboratory monitoring. J DERMATOL TREAT 2021; 33:2414-2424. [PMID: 34379039 DOI: 10.1080/09546634.2021.1967269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognised and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses has been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin, and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin.
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Affiliation(s)
- Haady Fallah
- The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,The Skin Hospital, Sydney, Australia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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Wu B, Yi X, Cui W, Rong T, Sang D, Xiao B, Zhao S, Wang D, Zhang J, Liu B. An Unrecognized Ligament and its Ossification in the Craniocervical Junction: Prevalence, Patient Characteristics, and Anatomic Evidence. Clin Orthop Relat Res 2021; 479:1816-1826. [PMID: 33739308 PMCID: PMC8277284 DOI: 10.1097/corr.0000000000001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the craniocervical junction, the ligaments between the anterior foramen magnum and the anterior arch of the atlas are not well defined, and ossification of the ligaments in this region has rarely been reported. Characterizing the anatomy and ossification of these ligaments may help in the diagnosis and treatment of disorders in this region. QUESTIONS/PURPOSES (1) What is the prevalence of an unrecognized ossification at the craniocervical junction in patients with cervical spine disorders, and what are the patient characteristics associated with this ossification? (2) Do patients with this ossification have a greater risk of ossification of other structures at the craniocervical junction or cervical spine? (3) Is there an unreported ligament at this ossified site? METHODS We conducted a retrospective study of 578 hospitalized patients who underwent CT for cervical spine disorders between January 2016 and July 2020. Based on the inclusion criteria, 11% (66 of 578) were excluded because of a cervical or craniocervical tumor, deformity, infection, fracture or dislocation, or prior surgery, leaving 89% (512 of 578) for analysis. These 512 patients had diagnoses of cervical radiculopathy, cervical myelopathy, cervical spondylotic amyotrophy, cervical spinal cord injury without a radiographic abnormality, or axial neck pain. Their mean age was 57 years (range 22-90 years), and 60% of the patients were men. Patient characteristics including age, gender, and diagnosis were retrieved from a longitudinally maintained institutional database. CT images were used to assess the presence of a previously unrecognized ossification and ossification of other structures in the craniocervical junction and cervical spine, including the posterior longitudinal ligament, anterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, and apical ligament, as well as diffuse idiopathic skeletal hyperostosis (DISH). The association between these structures was also assessed. This unreported ossification was called the capped dens sign. It was defined and graded from 1 to 3. Grade 3 was defined as the typical capped dens sign. Cervical spine MRI was used to assess whether there was an unreported structure in the same region as where the capped dens sign was detected on CT images. In the database of a recent study, there were 33 patients younger than 41 years. Nine percent (three of 33) were excluded because they did not have cervical spine MRI. MRIs of the remaining 30 patients were assessed. Their mean age was 35 years (range 22-40 years), and 58% were men. All cervical spine CT images and MRIs were reviewed by one senior spine surgeon and one junior spine surgeon twice with a 2-week interval. Blinding was accomplished by removing identifying information from the radiographs and randomly assigning them to each examiner. Any discrepancy with respect to the grade of the capped dens sign was adjudicated by a third blinded senior spine surgeon. Intrarater and interrater reliabilities were assessed by calculating weighted kappa statistics. No ligament or membrane was reported at this site. MRI is not sensitive to identify thin tissue in this region, especially when severe degeneration has occurred. A cadaveric study was conducted to discover a potential ligament between the inferior margin of the foramen magnum and the anterior arch of the atlas, as prompted by the newly discovered ossification in the clinical analysis of this study. Six embalmed human cadaveric craniocervical regions (three male and three female cadavers; median age 56 years, range 45-78 years) were dissected by a senior anatomist and a senior anatomy technician. A mid-sagittal section of the craniocervical junction was created, allowing us to explore the interval between the anterior foramen magnum and anterior arch of the atlas. A histologic analysis was conducted in two of the six cadavers (a male cadaver, 45 years; and a female cadaver, 51 years). Slides were made with 4-µm sections and stained with hematoxylin and eosin. RESULTS A novel capped dens sign was detected in 39% (198 of 512) of the patients and the most typical capped dens sign was detected in 19% (96 of 512) of patients. The prevalence of this sign was the highest in patients with cervical spondylotic amyotrophy (12 of 25 patients). The prevalence of ossification of the anterior longitudinal ligament, ligamentum nuchae, and apical ligament, as well as DISH, was higher in patients with a capped dens sign than in those without (p = 0.04, p < 0.001, p < 0.001, and p = 0.001, respectively). The capped dens sign was identified in 69% (18 of 26) of the patients with DISH. A thin and short band-like structure or osteophyte was detected on MRI in 87% (26 of 30), in the same region as the capped dens sign. In the cadaveric study, an unreported, distinct ligamentous structure was identified at this ossified site. It originated from the posterosuperior rim of the anterior arch of the atlas to the inferior margin of the foramen magnum, which we called the inter-atlanto-occipital ligament. It was found in all six dissected craniocervical junctions. The histologic analysis revealed dense connective tissue. CONCLUSION More than one-third of the patients in this series demonstrated CT evidence of a previously unrecognized ossification in the craniocervical junction, which we called the capped dens sign. Anatomic evidence of this sign, which was a previously unidentified ligament, was also newly discovered in this region. This study was conducted among Asian patients and specimens. Further studies among diverse ethnic groups may be needed to generalize the results. An additional well-designed prospective study will be needed to provide further evidence regarding the potential pathophysiology and clinical relevance of the capped dens sign. Furthermore, the cadaveric analysis in this study was only a preliminary report of the ligament; further biomechanical research is needed to investigate its function. CLINICAL RELEVANCE Knowledge of this novel ligament may improve the diagnosis and treatment of craniocervical stability and dislocation. Ossification of this ligament is correlated with age, cervical spondylotic amyotrophy, and DISH. We wonder whether patients with cervical degenerative disorders who also have a capped dens sign may be at risk for the formation of osteophytes of an uncovertebral joint, which may result in palsy of the upper limb muscles. The capped dens sign may be the craniocervical manifestation of DISH. This possible association between the capped dens sign and DISH should be considered when performing surgery on patients with the capped dens sign.
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Affiliation(s)
- Bingxuan Wu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yi
- Department of Human Anatomy, Medical School, Nantong University, Nantong, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianhua Rong
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dacheng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bowei Xiao
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuqing Zhao
- Department of Human Anatomy, Medical School, Nantong University, Nantong, China
| | - Dian Wang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianhao Zhang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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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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Hamaguchi H, Yumoto T, Mae S, Takeshita A, Aoyama M, Yamana K, Nakao A. Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211027988. [PMID: 34248361 PMCID: PMC8236763 DOI: 10.1177/11795476211027988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.
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Affiliation(s)
- Hisashi Hamaguchi
- Department of Emergency Medicine, Kasaoka Daiichi Hospital, Kasaoka, Okayama, Japan.,Department of Medical Education, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency Medicine, Kasaoka Daiichi Hospital, Kasaoka, Okayama, Japan.,Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Soichiro Mae
- Department of Emergency Medicine, Kasaoka Daiichi Hospital, Kasaoka, Okayama, Japan.,Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Ayumu Takeshita
- Department of Orthopedic Surgery, Kasaoka Daiichi Hospital, Kasaoka, Okayama, Japan
| | - Minae Aoyama
- Department of Orthopedic Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Keiya Yamana
- Department of Orthopedic Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
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Fournier DE, Beaucage KL, Beach RJ, Kiser PK, Séguin CA, Dixon SJ. Ectopic mineralisation of the mandibular symphysis in ENT1 knockout mice: A model of dystrophic calcification. Bone Rep 2021; 15:101100. [PMID: 34258331 PMCID: PMC8253951 DOI: 10.1016/j.bonr.2021.101100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
Equilibrative nucleoside transporter 1 (ENT1) transfers nucleosides, such as adenosine, across plasma membranes. We reported previously that mice lacking ENT1 (ENT1 -/- ) exhibit progressive ectopic calcification of spinal tissues-a phenotype resembling diffuse idiopathic skeletal hyperostosis (DISH) in humans. Our objective was to investigate potential calcification of orofacial tissues in ENT1 -/- mice. Heads of wild-type mice and ENT1 -/- mice from 3 to 17 months were evaluated using microcomputed tomography (μCT). Some heads were decalcified and processed for histological assessment. Other heads were examined using energy dispersive X-ray spectroscopy and micro X-ray diffraction. Using μCT, ENT1 -/- mice showed extensive radiopaque lesions within the mandibular symphysis, the severity of which increased with advancing age. Histologically, at 6 months these ectopic radiopacities were found to correspond to acellular, amorphous, eosinophilic material, with no evidence of inflammatory cells. Because lesions were localised to the symphysis, we identified early pathological changes at 3 months and observed that lesions initiated specifically within the fibrocartilage pad. Energy-dispersive X-ray spectroscopy of ectopic lesions revealed large amounts of calcium and phosphorous in a molar ratio of ~1.59, and X-ray diffraction profiles matched that of calcium-deficient hydroxyapatite. This is the first characterisation of ectopic calcifications within the mandibular symphysis of ENT1 -/- mice, indicating a role for ENT1 and adenosine metabolism in regulating calcification of fibrocartilaginous tissues. Moreover, these murine lesions resemble areas of dystrophic calcification in the spinal tissues of humans with DISH. Importantly, ectopic calcifications develop in a reproducible temporal pattern within a well-defined anatomical region and, thus, provide a model for determining the cellular and molecular pathways underlying ectopic calcification in DISH and related disorders.
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Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - Kim L Beaucage
- Dentistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Ryan J Beach
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Patti K Kiser
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Cheryle A Séguin
- Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - S Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada.,Dentistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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65
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Gao K, Cao Y, Liu W, Sun S, Wu Y, Yu W. Anterior cervical surgery to treat diffuse idiopathic skeletal hypertrophic combined with cervical disc herniation: A case report. Medicine (Baltimore) 2021; 100:e26097. [PMID: 34087855 PMCID: PMC8183831 DOI: 10.1097/md.0000000000026097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by calcification of anterolateral ligaments of the spine and the rest of the body. DISH combined with disc herniation induces complex symptoms and is more difficult to treat. Here, we describe a complicated case of a patient diagnosed with DISH as well as cervical disc herniation that was successfully treated using anterior cervical surgery. PATIENTS CONCERN A 69-year-old Asian male experienced dysphagia and weakness in his left limbs. He also experienced a stiff neck and right slant over a 6-month period. DIAGNOSIS An X-ray revealed calcification of the C4-7 vertebral front edge and a narrowed intervertebral space between C5/6. Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) both showed compression of the spinal cord at the cervical 5/6. Esophagography revealed that osteophytes in the anterior margin of vertebral body (C4-C7) oppressed the esophagus. INTERVENTIONS An operation focused on anterior cervical C5/6 disc fusion and anterior vertebral C4-7 osteophyte removal was performed. OUTCOMES After the operation, X-ray and CT showed that most osteophytes were removed and spinal cord compression was relieved. One day following the operation, both dysphagia and numbness in limbs were improved. Strong recovery was observed at the three-month follow-up exam. LESSONS This complex DISH combined with disc herniation case is rarely observed in patients. Anterior cervical disc fusion and anterior vertebral osteophyte removal were effective treatment measures. This case study provides insight into treating cases presented with cervical spine complications associated with DISH combined with other ailments.
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Guiot A, Estublier C, Gaude M, Szulc P, Chapurlat R. Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men. Rheumatology (Oxford) 2021; 60:2197-2205. [PMID: 33200181 DOI: 10.1093/rheumatology/keaa517] [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: 11/11/2019] [Revised: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. METHODS In 782 men ages 50-85 years, DISH was diagnosed using Resnick's criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. RESULTS Men with DISH had higher BMD at the lumbar spine (P < 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P < 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P < 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P < 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P < 0.05), mainly in men with higher spine BMD (>0.9 g/cm2; ΔAUC = +0.189, P < 0.001). DISH was not associated with the risk of non-vertebral fracture. CONCLUSION DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.
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Affiliation(s)
- Anaïs Guiot
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1
| | - Charline Estublier
- INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon.,Service de Rhumatologie, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Marine Gaude
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1
| | - Pawel Szulc
- INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon
| | - Roland Chapurlat
- Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.,Faculté de Médecine, Université Claude Bernard Lyon 1.,INSERM UMR 1033, Hôpital Edouard Herriot, Pavillon F, Lyon
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67
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Yan C, Tan HY, Ji CL, Yu XW, Jia HC, Li FD, Jiang GC, Li WS, Zhou FF, Ye Z, Sun JC, Shi JG. The clinical value of three-dimensional measurement in the diagnosis of thoracic myelopathy caused by ossification of the ligamentum flavum. Quant Imaging Med Surg 2021; 11:2040-2051. [PMID: 33936985 DOI: 10.21037/qims-20-713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Thoracic ossification of the ligamentum flavum (OLF) is a major cause of thoracic myelopathy, which is often accompanied by multiple segmental stenosis or other degenerative spinal diseases. However, in the above situations, it is difficult to determine the exact segment responsible. The objective of this study was to analyze three-dimensional (3D) radiological parameters in order to establish a novel diagnostic method for discriminating the responsible segment in OLF-induced thoracic myelopathy, and to evaluate its superiority compared to the conventional diagnostic methods. Methods Eighty-one patients who underwent surgery for thoracic myelopathy caused by OLF from 2016 to 2020 were enrolled in this study as the myelopathy group, and 79 patients who had thoracic OLF but displayed no definite neurological signs from 2018 to 2020 were enrolled as the non-myelopathy group. We measured the one-dimensional (1D), two-dimensional (2D), and 3D radiological parameters, calculated their optimal cutoff values, and compared their diagnostic values. Results Significant differences were observed in the 1D, 2D, and 3D radiological parameters between the myelopathy and non-myelopathy groups (P<0.01). As a 3D radiological parameter, the OLF volume (OLFV) ratio (OLFV ratio = OLFV/normal canal volume × 100%) was the most accurate parameter for diagnosing OLF-induced thoracic myelopathy, with a diagnostic coincidence rate of 88.1%. We also found that an OLFV ratio of 26.3% could be used as the optimal cutoff value, with a sensitivity of 87.7% and a specificity of 88.6%. Moreover, the OLFV ratio [area under the curve (AUC): 0.92, 95% confidence interval (CI): 0.86-0.95] showed a statistically higher diagnostic value than the 1D and 2D parameters (AUC: 0.75, 95% CI: 0.67-0.81; AUC: 0.84, 95% CI: 0.77-0.89, respectively) (P<0.05). Pearson correlation analysis illustrated that the OLFV ratio was significantly negatively correlated with preoperative modified Japanese Orthopedic Association (mJOA) score (r=-0.73, 95% CI: -0.81 to -0.60, P<0.01). Conclusions Our results demonstrate the superiority of the OLFV ratio over the conventional 1D and 2D computed tomography (CT)-based radiological parameters for the diagnosis of OLF-induced thoracic myelopathy. The novel diagnostic method based on the OLFV ratio will help to determine the responsible segment in multi-segmental thoracic OLF or when thoracic OLF coexists with other degenerative spinal diseases. The OLFV ratio also accurately reflects the clinical state of symptomatic patients with thoracic OLF.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Hao-Yuan Tan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Cheng-Long Ji
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xue-Wei Yu
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Fu-Dong Li
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Gui-Cheng Jiang
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Shi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Fei-Fei Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhen Ye
- Shanghai Electric Group Limited Liability Company Central Academe, Shanghai, China
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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68
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Intercostal artery rupture associated with thoracic spinal hyperextension injury caused by a minor trauma: A case report. Trauma Case Rep 2021; 33:100487. [PMID: 33997230 PMCID: PMC8102801 DOI: 10.1016/j.tcr.2021.100487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/22/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis is associated with hyperextension injury of the spine caused by a minor trauma and may often be diagnosed late, thus preventing effective treatment. To date, there have been no reported cases of segmental arterial injury associated with a hyperextension injury caused by a minor trauma in super-elderly patients with diffuse idiopathic skeletal hyperostosis. Herein, we present the findings and treatment provided for a 92-year-old woman with a right massive hemothorax and 12th thoracic vertebral fracture. The patient was diagnosed with diffuse idiopathic skeletal hyperostosis. Bleeding stopped naturally, and we successfully treated the patient using posterior fixation with percutaneous pedicle screws. At 6 months post-surgery, there was no complication, instrumentation failure, or correction loss, and she could walk independently using a cane. To our knowledge, this is the first report of intercostal artery rupture and massive hemothorax associated with diffuse idiopathic skeletal hyperostosis fracture caused by a minor trauma. It is notable that diffuse idiopathic skeletal hyperostosis following a minor trauma in such elderly patients may cause segmental arterial rupture associated with spinal burst fracture and hyperextension injury.
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69
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Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia-Molecular and Clinical Aspects. Int J Mol Sci 2021; 22:ijms22084255. [PMID: 33923907 PMCID: PMC8074005 DOI: 10.3390/ijms22084255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of the ligaments of the cervical spine; in some cases, it may result in dysphagia. The condition is more common in men over 50 years of age with metabolic disorders, and it is often asymptomatic and not a major issue for patients. The etiology of DISH is poorly understood, and known genetic factors indicate multiple signal pathways and multigene inheritance. In this review, we discuss the epidemiological, clinical, and etiological aspects of DISH with a special focus on dysphagia.
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70
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Mader R, Baraliakos X, Eshed I, Novofastovski I, Bieber A, Verlaan JJ, Kiefer D, Pappone N, Atzeni F. Imaging of diffuse idiopathic skeletal hyperostosis (DISH). RMD Open 2021; 6:rmdopen-2019-001151. [PMID: 32111653 PMCID: PMC7046956 DOI: 10.1136/rmdopen-2019-001151] [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: 11/23/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 01/26/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterised by calcification and ossification of ligaments and entheses. The condition usually affects the axial skeleton, in particular, at the thoracic segment, though also other portions of the spine are often involved. DISH often involves also peripheral tendinous and/or entheseal sites either alone, or in association with the involvement of peripheral joints. At times, new bone formation involves the bone itself, but sometimes it involves joints not usually affected by osteoarthritis (OA) which result in bony enlargement of the epiphysis, joints space narrowing and a reduced range of motion. Because of the entheseal involvement, DISH can be mistaken for seronegative spondyloarthropathies or for a "simple" OA. Furthermore, other implications for the recognition of DISH include spinal fractures, difficult intubation and upper endoscopies, decreased response rates in DISH with concomitant spondyloarthritides, and increased likelihood to be affected by metabolic syndrome and cardiovascular diseases. This Atlas is intended to show the imaging finding in DISH in patients diagnosed with the condition by the Resnick classification criteria.
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Affiliation(s)
| | - Xenofon Baraliakos
- Rheumatologie Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Iris Eshed
- Department of Radiology, Musculoskeletal imaging Center, Tel Aviv University Israel, Tel Aviv, Israel
| | | | | | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David Kiefer
- Rheumatologie, Rheumazentrum Ruhrgebiet, Herne, NRW, Germany.,Rheumatologie, Ruhr-Universitat Bochum, Bochum, Germany
| | - Nicola Pappone
- Rheumatology Rehabilitation, Fondazione S. Maugeri, Telese Terme, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal and Experimental Medicine, University of Messina, Messina, Italy
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Cudrici CD, Newman KA, Ferrante EA, Huffstutler R, Carney K, Betancourt B, Miettinen M, Siegel R, Katz JD, Nesti LJ, St Hilaire C, Lakshmipathy D, Wen H, Bagheri MH, Boehm M, Brofferio A. Multifocal Calcific Periarthritis with Distinctive Clinical and Radiological Features in Patients with CD73 Deficiency. Rheumatology (Oxford) 2021; 61:163-173. [PMID: 33744914 DOI: 10.1093/rheumatology/keab270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Arterial calcification due to deficiency of CD73 (ACDC) is a hereditary autosomal recessive ectopic mineralization syndrome caused by loss-of-function mutations in the 5'-nucleotidase Ecto (NT5E) gene. Periarticular calcification has been reported but the clinical characterization of arthritis as well as the microstructure and chemical composition of periarticular calcifications and synovial fluid crystals has not been systematically investigated. METHODS Eight ACDC patients underwent extensive rheumatological and radiological evaluation over a period of 11 years. Periarticular and synovial biopsies were obtained from four patients. Characterization of crystal composition was evaluated by compensated polarized light microscopy, Alizarin red staining for synovial fluid along with x-ray diffraction and x-ray micro tomosynthesis for periarticular calcification. RESULTS Arthritis in ACDC patients has a clinical presentation of mixed erosive-degenerative joint changes with a median onset of articular symptoms at 17 years of age and progresses over time to the development of fixed deformities and functional limitations of small peripheral joints with eventually, larger joint and distinct axial involvement later in life. We have identified calcium pyrophosphate (CPP) and calcium hydroxyapatite (CHA) crystals in synovial fluid specimens and determined that CHA crystals are the principal component of periarticular calcifications. CONCLUSION This is the largest study in ACDC patients to describe erosive peripheral arthropathy and axial enthesopathic calcifications over a period of 11 years and the first to identify the composition of periarticular calcifications and synovial fluid crystals. ACDC should be considered among the genetic causes of early-onset osteoarthritis, as musculoskeletal disease signs may often precede vascular symptoms.
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Affiliation(s)
- Cornelia D Cudrici
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Kam A Newman
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Elisa A Ferrante
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Rebecca Huffstutler
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Katherine Carney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Blas Betancourt
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA.,University of Florida, Division of Rheumatology & Clinical Immunology, Department of Medicine, Gainesville, FL, USA
| | - Markku Miettinen
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Richard Siegel
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA.,Novartis Institutes of Biomedical Research, Novartis Institutes of Biomedical Research, Translational Medicine, Autoimmunity, Transplantation and Inflammation Disease Area, Basel, CH USA
| | - James D Katz
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Leon J Nesti
- Walter Reed National Military Medical Center, Clinical and Experimental Orthopaedics, Bethesda, MD, USA
| | - Cynthia St Hilaire
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Cardiology, Department of Bioengineering, and Vascular Medicine Institute, Pittsburgh, PA, USA
| | - Deepak Lakshmipathy
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Han Wen
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Mohammad H Bagheri
- National Institutes of Health, Department of Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Manfred Boehm
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Alessandra Brofferio
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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72
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Wang C, Wang QZ, Gao JH, Zhang L, Zhang L, Chen BH. Clinical Comparison of Selective versus Nonselective Decompression for Symptomatic Tandem Stenosis of the Cervical and Thoracic Spine: A Retrospective Cohort Study. Orthop Surg 2021; 13:537-545. [PMID: 33619891 PMCID: PMC7957417 DOI: 10.1111/os.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of the present paper was to reveal the clinical differences between selective and nonselective decompression for symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS). METHODS A total of 34 patients were eligible and included in the study. Among them, 8 patients underwent selective cervical decompression (CD), 15 patients underwent selective thoracic decompression (TD), and 11 patients underwent combined CD and TD (CTD) surgery. Age, sex, operative time, intraoperative blood loss, postoperative hospital stay, inpatient expenditure, preoperative upper Japanese Orthopaedic Association (JOA) rate, canal occupation rate, high-intensity T2-weighted image (T2WI) of the spinal cord, and preoperative and postoperative JOA scores were compared among the three groups. RESULTS The CD group had shorter operative time (138.8 ± 36.1 vs 229.7 ± 95.8 vs 328.6 ± 94.8, min, P < 0.001), less intraoperative blood loss (141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5, mL, P = 0.004), and shorter postoperative hospital stay (4.6 ± 1.6 vs 9.0 ± 3.5 vs 10.3 ± 6.6, days, P = 0.008), as well as lower preoperative upper JOA rate (34.1 ± 5.6 vs 53.9 ± 8.4 vs 48.2 ± 15.2, %, P = 0.001) than the TD and CTD groups. The CTD group had higher inpatient expenditure than the CD and TD groups (87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715, CNY, P < 0.001). The cervical canal occupation rates were similar among different groups (P > 0.05); however, the TD group showed a higher thoracic canal occupation rate than the CD group (58.3 ± 14.7 vs 43.3 ± 12.3, %, P = 0.035). All positive levels in high-intensity T2WI of the spinal cord were decompressed. The preoperative JOA scores as well as the postoperative JOA scores at 6 months and at last follow-up were comparable among the three groups (P > 0.05). Similarly, the JOA recovery rate showed no significant difference among the groups (P > 0.05). CONCLUSION Selective CD or TD alone demonstrated similar clinical effectiveness to nonselective and combined CTD for TSCTS. Individualized surgical decision should be made after meticulous assessments of clinical and radiological manifestations, general patient condition, and socioeconomic factors.
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Affiliation(s)
- Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi-Zun Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing-Hao Gao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liang Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bo-Hua Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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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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Mader R, Pappone N, Baraliakos X, Eshed I, Sarzi-Puttini P, Atzeni F, Bieber A, Novofastovski I, Kiefer D, Verlaan JJ, Ambrosino P, Buskila D, Armas JB, Khan MA. Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component. Curr Rheumatol Rep 2021; 23:6. [PMID: 33496875 DOI: 10.1007/s11926-020-00972-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Diffuse Idiopathic Skeletal Hyperostosis (DISH) is considered a metabolic condition, characterized by new bone formation affecting mainly at entheseal sites. Enthesitis and enthesopathies occur not only in the axial skeleton but also at some peripheral sites, and they resemble to some extent the enthesitis that is a cardinal feature in spondyloarthritis (SpA), which is an inflammatory disease. RECENT FINDINGS We review the possible non-metabolic mechanism such as inflammation that may also be involved at some stage and help promote new bone formation in DISH. We discuss supporting pathogenic mechanisms for a local inflammation at sites typically affected by this disease, and that is also supported by imaging studies that report some similarities between DISH and SpA. Local inflammation, either primary or secondary to metabolic derangements, may contribute to new bone formation in DISH. This new hypothesis is expected to stimulate further research in both the metabolic and inflammatory pathways in order to better understand the mechanisms that lead to new bone formation. This may lead to development of measures that will help in earlier detection and effective management before damage occurs.
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Affiliation(s)
- Reuven Mader
- Rheumatic Diseases Unit, Ha'Emek MC, Afula, Israel.
| | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Iris Eshed
- Department of Radiology, Musculoskeletal imaging Unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Amir Bieber
- Rheumatic Diseases Unit, Ha'Emek MC, Afula, Israel
| | | | - David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Bochum, Germany
| | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Dan Buskila
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacome Bruges Armas
- Medicine, Rheumatology, SEEBMO, Hospital de Santo Espirito da ilha Terceira, Universidade do Porto, Angra do Heroismo, Portugal
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Mizutani Y, Okuda A, Maegawa N, Tada Y, Takano K, Asai H, Watanabe T, Kawai Y, Shigematsu H, Urisono Y, Fukushima H, Okuchi K, Tanaka Y. Esophageal incarceration associated with cervical vertebral fracture in a patient with diffuse idiopathic skeletal hyperostosis. J Orthop Sci 2021; 26:182-185. [PMID: 29935973 DOI: 10.1016/j.jos.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/07/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Yasushi Mizutani
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yusuke Tada
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Keisuke Takano
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Tomoo Watanabe
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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76
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Diffuse idiopathic skeletal hyperostosis: A potential factor in the induction of thoracic spondylotic myelopathy. J Orthop Sci 2021; 26:75-78. [PMID: 32063469 DOI: 10.1016/j.jos.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thoracic spondylotic myelopathy (TSM) commonly occurs at the thoracolumbar junction, and mechanical stress is thought to be involved. In DISH, the anterior longitudinal ligament becomes ossified. Although DISH is suspected to be involved in TSM pathology, reports are limited. Aim of this study is to investigate the association between (TSM) and diffuse idiopathic skeletal hyperostosis (DISH). METHODS Fifty-one patients with thoracic myelopathy underwent surgery between April 2008 and April 2017. Of these, 28 patients with TSM were included and examined. DISH was confirmed using computed tomography (CT). Subjects were divided into DISH and non-DISH sub-groups according to CT findings, and the DISH coexistence rate was calculated. Groups were analyzed for sex, age, postoperative Japanese Orthopedic Association (JOA) score, and reoperation status. In the DISH group, the positional relationship between the affected vertebral level of TSM and consecutive vertebral bone bridges was analyzed. Patients without spinal disease matched for sex and age were enrolled as controls (N = 56). The DISH coexistence rate was compared and analyzed between groups. RESULTS Mean age at surgery was 67.8 years (43-82 years; 22 men, 6 women). DISH was detected in 17 of 28 patients (60.7%; 15 men, 2 women). No significant difference in the improvement rate of JOA score was observed between groups. TSM occurred at: lower border of a consecutive vertebral bone bridge, N = 4; upper border, N = 3; between consecutive vertebral bone bridges, N = 5; one vertebral body away from a consecutive vertebral bone bridge, N = 5. No patient had TSM occurring within a consecutive vertebral bone bridge. The DISH coexistence rate in patients with TSM (60.7%) was significantly higher than that in controls (20/56, 35.7%) (p = 0.03). CONCLUSION Mechanical stress caused by consecutive vertebral bone bridges due to DISH may be involved in TSM pathogenesis. Therefore, in DISH patients, attention needs to be paid to TSM onset.
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Licini C, Farinelli L, Cerqueni G, Hosein A, Marchi S, Gigante A, Mattioli-Belmonte M. Heterotopic ossification in a patient with diffuse idiopathic skeletal hyperostosis: Input from histological findings. Eur J Histochem 2020; 64. [PMID: 33272008 PMCID: PMC7731577 DOI: 10.4081/ejh.2020.3176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
A high incidence of heterotopic ossification (HO) has been reported in patients with diffuse idiopathic skeletal hyperostosis (DISH), a metabolic disease characterized by calcifications of entheses at spine and peripheral sites. We performed histological and immunohistochemical analyses in five different HO sites in a patient with DISH to study a possible mutual interaction of bone morphogenetic protein 2 (BMP-2), transforming growth factor beta (TGF-β), and decorin, crucial for bone mass increasing, matrix calcification, and endochondral bone formation. We speculated that the surgical trauma triggered HO, inducing TGF-β release at the lesion site. TGF-β recruits osteoblast precursor cells and determines the overexpression of BMP-2 in the surrounding skeletal muscle, inducing a further osteogenic differentiation, contributing to HO onset.
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Affiliation(s)
- Caterina Licini
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Luca Farinelli
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Giorgia Cerqueni
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Andrell Hosein
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Saverio Marchi
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Antonio Gigante
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Monica Mattioli-Belmonte
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
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Zarei M, Golbakhsh M, Rostami M, Moosavi M. Dysphonia, Stridor, and Dysphagia Caused By Diffuse Idiopathic Skeletal Hyperostosis: Case Report and Review of Literature. Adv Biomed Res 2020; 9:47. [PMID: 33457330 PMCID: PMC7792880 DOI: 10.4103/abr.abr_50_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/06/2020] [Accepted: 06/20/2020] [Indexed: 11/06/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) also known as Forestier disease is a noninflammatory, systemic skeletal disease of unknown etiology. DISH is usually asymptomatic but may compress the posterior wall of the aero digestive tract and lead to dysphagia, globus, hoarseness, stridor, dyspnea, and neurological problems. Although dysphagia is not uncommon among the presenting symptoms of DISH but dysphonia and stridor are rarely reported. We report a 68-year-old man who presented with a history of progressive dysphagia over 1 year and recent dysphonia and stridor secondary to cervical osteophytes. We discuss the symptoms, radiological features, and management of this uncommon case of DISH in conjunction with review of literature.
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Affiliation(s)
- Mohammad Zarei
- Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Rostami
- Department of Neurosurgery, Shariatic Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran
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79
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DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS WITH SECONDARY DYSPHAGIA IN A BLACK-HANDED SPIDER MONKEY ( ATELES GEOFFROYI). J Zoo Wildl Med 2020; 51:455-458. [PMID: 32549579 DOI: 10.1638/2018-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2020] [Indexed: 11/21/2022] Open
Abstract
A 32-yr-old male black-handed spider monkey (Ateles geoffroyi) with marked kyphosis and reduced spinal range of motion developed intermittent regurgitation, which was managed with an acid reducer. Diffuse idiopathic skeletal hyperostosis (DISH) was suspected in this animal due to radiographically evident ossification of the anterior longitudinal ligament. At repeat radiographic evaluation 1.5 yr later, due to weight loss and increased frequency of regurgitation, the cervical spine was deviated ventrally and appeared to be impinging on the thoracic inlet. The spider monkey was humanely euthanized due to poor prognosis, and the presumptive diagnosis of DISH was confirmed via postmortem computed tomography and necropsy. DISH has not been reported in black-handed spider monkeys, and secondary dysphagia, an uncommon but recognized consequence in humans, has not been reported in a nonhuman primate. Earlier recognition of this possibly underreported disease process may increase treatment options and effectiveness of intervention.
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80
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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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Dąbrowski M, Sulewski A, Kaczmarczyk J, Kubaszewski Ł. Surgical treatment of diffuse idiopathic skeletal hyperostosis of cervical spine with dysphagia - Case report. Ann Med Surg (Lond) 2020; 57:37-40. [PMID: 32714523 PMCID: PMC7369420 DOI: 10.1016/j.amsu.2020.07.009] [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: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Diffuse idiopathic skeletal hyperostosis of cervical spine can lead to dysphagia. Presentation of case A 73-year-old male weighing 110 kg and diagnosed with diffuse idiopathic skeletal hyperostosis in cervical spine with dysphagia. Patient manifested local pain of neck, a gradual limitation of spinal mobility. The surgery decision was based on swallowing problems, not pain in the spine. Before surgery radiographs, magnetic resonance images, computed tomography of the cervical spine and gastroscopy were obtained. Osteophytes were removed from the anterior approach with present otolaryngologist by surgery. Discussion In this case used gastroscopy, CT and MRI for diagnostics. During the procedure we had support otolaryngologist. The patient has not been found a stenosis spinal canal and neurological symptoms. We were removed the ostheophytes. Interbody implants have not been applied. Conclusion Disc degeneration disease itself can be asymptomatic or not a dominant problem for the DISH patients. Clinical signs may pharyngoesophageal and tracheal compression, causing dysphagia, shortness of breath and stridor. In this case, the cervical spine was stability and not demonstrated a stenosis in the spinal canal. Isolate removing of the osteophytes without implants in DISH of cervical spine can be enough solution.
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Affiliation(s)
- Mikołaj Dąbrowski
- Department of Spine Orthopedics and Biomechanics, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland.,W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Adam Sulewski
- W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Jacek Kaczmarczyk
- W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Łukasz Kubaszewski
- Department of Spine Orthopedics and Biomechanics, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland.,W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
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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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83
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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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Fournier DE, Kiser PK, Beach RJ, Dixon SJ, Séguin CA. Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis (DISH). Bone Res 2020; 8:16. [PMID: 32257530 PMCID: PMC7118090 DOI: 10.1038/s41413-020-0091-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 12/18/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a prevalent noninflammatory spondyloarthropathy characterized by ectopic mineral formation along the anterolateral aspect of the vertebral column, yet little is known about its underlying pathogenesis. Our objective was to evaluate the histopathological features and composition of ectopic mineral within spinal tissues affected by DISH in humans. Thoracic spine segments from six embalmed cadaveric donors (one female and five males; median age 82 years) meeting the radiographic diagnostic criteria for DISH were evaluated using radiological, histological, and physical analyses. Overall, the histological features of ectopic mineralization at individual motion segments were heterogeneous, including regions of heterotopic ossification and dystrophic calcification. Heterotopic ossifications were characterized by woven and lamellar bone, multifocal areas of metaplastic cartilage, and bony bridges along the anterior aspect of the intervertebral disc space. Dystrophic calcifications were characterized by an amorphous appearance, a high content of calcium and phosphorus, an X-ray diffraction pattern matching that of hydroxyapatite, and radiodensities exceeding that of cortical bone. Dystrophic calcifications were found within the anterior longitudinal ligament and annulus fibrosus in motion segments both meeting and not meeting the radiographic criteria for DISH. In summary, our findings indicate that in DISH, ectopic mineral forms along the anterior aspect of the spine by both heterotopic ossification and dystrophic calcification of fibrocartilaginous tissues. Although both types of ectopic mineralization are captured by current radiographic criteria for DISH, dystrophic calcification may reflect a distinct disease process or an early stage 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 N6A 5B9 Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4 Canada
| | - Patti K. Kiser
- Department of Laboratory Medicine and Pathology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1 Canada
| | - Ryan J. Beach
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1 Canada
| | - S. Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4 Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1 Canada
| | - Cheryle A. Séguin
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4 Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1 Canada
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Chung YS, Zhang HY, Ha Y, Park JY. Surgical Outcomes of Dysphagia Provoked by Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine. Yonsei Med J 2020; 61:341-348. [PMID: 32233177 PMCID: PMC7105401 DOI: 10.3349/ymj.2020.61.4.341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST). MATERIALS AND METHODS In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS. RESULTS Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020). CONCLUSION Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.
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Affiliation(s)
- Young Soo Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Yeol Zhang
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoon Ha
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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86
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Diffuse Idiopathic Skeletal Hyperostosis in a Patient With Shoulder Pain. J Orthop Sports Phys Ther 2020; 50:215. [PMID: 32241232 DOI: 10.2519/jospt.2020.9243] [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] [Indexed: 02/07/2023]
Abstract
A 74-year-old man was referred to physical therapy by his primary care physician for insidious onset of right shoulder pain. Following examination, spinal radiographs and the human leukocyte antigen (HLA-B27) test, which is used to identify common autoimmune disorders, were completed. The radiographs revealed multilevel changes consistent with diffuse idiopathic skeletal hyperostosis, and the HLA-B27 test was positive. J Orthop Sports Phys Ther 2020;50(4):215. doi:10.2519/jospt.2020.9243.
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87
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García Callejo FJ, Oishi N, López Sánchez I, Pallarés Martí B, Rubio Fernández A, Gómez Gómez MJ. Incidence of Diffuse Idiopathic Skeletal Hyperostosis From a Model of Dysphagia. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Broitman S, Herman A, Stern M, Lidar M, Eshed I. Enthesopathy of the anterior chest wall joints in patients with diffuse idiopathic skeletal hyperostosis (DISH): a retrospective analysis of computed tomography scans. Skeletal Radiol 2020; 49:461-467. [PMID: 31501958 DOI: 10.1007/s00256-019-03307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and characterize anterior chest wall (ACW) joint's enthesopathy on CT scans in patients with DISH compared with age- and gender-matched control group. MATERIAL AND METHODS Retrospective evaluation for enthesopathy features of ACW joints-sterno-clavicular (SCJ), manubrio-sternal (MSJ), costo-sternal 1-7 (CSJ)-on chest CT scans of subjects with DISH (Resnick criteria) and of age- and gender-matched control subjects was performed. 183 subjects (DISH: 92, control: 91); male:female: 126:57, average age: 71.7 years (range 50-94) were evaluated. Total enthesopathy scores per subjects and per each joint were compared. RESULTS Total enthesopathy score of ACW joints was significantly higher among DISH compared to controls (64.03 ± 15.1, 50.47 ± 12.4, p < 0.001). At joint level, SCJ and CSJ enthesopathy, but not MSJ was significantly more prevalent in DISH compared to controls. CONCLUSION ACW joints' enthesopathy as seen on CT scans, an entity not included in the Resnick classification criteria, is common among DISH subjects. The difference between SCJ and CSJ prevalence compared to MSJ may result from different joint type. ACW joints' enthesopathy may be considered to be included in future modified radiographic criteria for DISH.
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Affiliation(s)
- Shani Broitman
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Amir Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, affiliated to Ben Gurion University, Beer Sheva, Israel
| | - Myriam Stern
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel.
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90
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Pini SF, Sgaramella GA, Pariente-Rodrigo E, Ramos-Barrón MC, Olmos-Martínez JM, Hernández-Hernández JL. Trabecular bone score and bone turnover markers in men with DISH: Data from the Camargo Cohort study. Semin Arthritis Rheum 2020; 50:1521-1524. [PMID: 32093967 DOI: 10.1016/j.semarthrit.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/10/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with an increased risk of vertebral fracture. To date, no studies have investigated the relationship between DISH and bone microstructure assessed by the trabecular bone score (TBS). METHODS Cross-sectional study, nested in a prospective population-based cohort. All men (968) aged≥50 years were included. Clinical covariates, DISH, TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. RESULTS Mean age of participants was 65 ± 9 years. 207 (21.6%) had DISH. DISH subjects were older, had higher body mass index (BMI) and abdominal perimeter, lower glomerular filtration rate (GFR), and higher prevalence of metabolic syndrome (MetS) than non-DISH (NDISH) subjects. Bone mineral density at the lumbar spine (LS-BMD) was significantly higher in the DISH group. TBS values were 1.317 [1.303-1.331] for DISH and 1.334 [1.327-1.341] for NDISH subjects, after adjusting by age, BMI, abdominal perimeter, arterial hypertension, diabetes mellitus, MetS, GFR, serum alkaline phosphatase (ALP), LS and femoral neck BMD (p = 0.03). Serum ALP levels were higher in DISH subjects, showing an inverse correlation with TBS that remained significant after adjusting by age and BMI. CONCLUSIONS TBS values were significantly lower in men with DISH irrespective of age, BMI and BMD, suggesting that the presence of DISH might be related to a worse trabecular microstructure.
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Affiliation(s)
- Stefanie F Pini
- Home Hospitalization Service, Hospital Marqués de Valdecilla, Cantabria, Spain
| | - Giusi A Sgaramella
- Home Hospitalization Service, Hospital Marqués de Valdecilla, Cantabria, Spain
| | | | | | - José M Olmos-Martínez
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, Cantabria, Spain; University of Cantabria, Cantabria, Spain
| | - José L Hernández-Hernández
- Bone Metabolism Unit, Department of Internal Medicine, Hospital Marqués de Valdecilla, Cantabria, Spain; University of Cantabria, Cantabria, Spain.
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Yahara Y, Yasuda T, Kawaguchi Y, Suzuki K, Seki S, Kondo M, Makino H, Kamei K, Kanamori M, Kimura T. Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis. BMC Musculoskelet Disord 2020; 21:93. [PMID: 32041573 PMCID: PMC7011504 DOI: 10.1186/s12891-020-3105-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/31/2020] [Indexed: 01/15/2023] Open
Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. Methods A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. Results The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH- group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. Conclusions Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.
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Affiliation(s)
- Yasuhito Yahara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Miho Kondo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Parperis K. Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years. Ann Rheum Dis 2019; 81:e7. [DOI: 10.1136/annrheumdis-2019-216773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022]
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93
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Nguyen TT, Melendez PE, Kaproth-Joslin K, Bhatt AA. Non-neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging. Insights Imaging 2019; 10:116. [PMID: 31802262 PMCID: PMC6893007 DOI: 10.1186/s13244-019-0790-y] [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: 04/16/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
The thoracic inlet is located at the crossroads between imaging of the neck and chest. It represents an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many important body systems are located within this region, including the enteric, respiratory, vascular, lymphatic, neurologic, and endocrine systems. A detailed examination of this region is essential when reviewing neck and thoracic imaging. This article will discuss the normal anatomic boundaries of the thoracic inlet and present an image-rich systematic discussion of the non-neoplastic pathology that can occur in this region. The neoplastic pathology of the thoracic inlet will be covered in a companion article.
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Affiliation(s)
- Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA.
| | - Patricia E Melendez
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | | | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Qian Y, Liu W, Wang W, Fan C. Obesity may be a risk factor for recurrent heterotopic ossification in post-traumatic stiff elbow among children and teenagers. Orthop Traumatol Surg Res 2019; 105:1193-1198. [PMID: 31088773 DOI: 10.1016/j.otsr.2019.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/14/2019] [Accepted: 03/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Post-traumatic elbow stiffness and heterotopic ossification (HO) affects long-term life quality, as commonly in children and teenagers as in grownups. Childhood obesity considerably influences public health because it causes stroke, hypertension and diabetes mellitus. Previous research discussed its clinical complications in orthopedic diseases. However, no clinical research reveals the interaction between childhood obesity and HO after elbow injuries. HYPOTHESIS Obesity might be a risk factor of recurrent HO after elbow arthrolysis in children and teenagers, correlated with the severity of postoperative HO. METHODS Fifty seven post-traumatic children and teenagers undergoing elbow arthrolysis were retrospectively reviewed and divided into underweight/normal-weight group (n=28) and overweight/obese group (n=29) according to the gender-specific body mass index (BMI)-for-age growth chart. The Hastings and Graham classification was used to evaluate HO recurrence. We also assessed Mayo elbow performance scores and range of motion. RESULTS The mean age, gender, pathogenesis, side of injury, time of injury, follow-up duration were analyzed. Overweight/obese children and teenagers were more likely to develop recurrent HO (p=0.005) than underweight/normal-weight children and teenagers. A significant difference in the severity of recurrent HO between two groups was confirmed (p=0.028). The range of motion was improved greatly in underweight/normal-weight group compared with that in overweight/obese group (p=0.001). CONCLUSIONS The HO recurrence difference between two groups confirmed the hypothesis. Although underlying mechanisms are unclear, weight control might promote postoperative and long-term rehabilitation of the elbow joint for children and teenagers. LEVEL OF EVIDENCE III, retrospective cohort study, treatment study.
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Affiliation(s)
- Yun Qian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wenjun Liu
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, China; Taishan Medical University, Taian, 271016, China
| | - Wei Wang
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, China.
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, China.
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95
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Latourte A, Moltó A. Reply. Arthritis Care Res (Hoboken) 2019; 71:1150. [DOI: 10.1002/acr.23744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Augustin Latourte
- Paris Descartes UniversityAP‐HP de Paris and Hôpital CochinINSERM U1153PRES Sorbonne Paris‐Cité Paris France
| | - Anna Moltó
- Paris Descartes UniversityAP‐HP de Paris and Hôpital CochinINSERM U1153PRES Sorbonne Paris‐Cité Paris France
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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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Liang H, Liu G, Lu S, Chen S, Jiang D, Shi H, Fei Q. Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals. BMC Musculoskelet Disord 2019; 20:253. [PMID: 31128588 PMCID: PMC6534908 DOI: 10.1186/s12891-019-2569-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/12/2019] [Indexed: 01/26/2023] Open
Abstract
Background The epidemiology and cause of ossification of the spinal ligaments (OSL) remains obscure. To date, there is no study that comprehensively evaluates the prevalence, distribution, and concomitance of each type of OSL by CT among general Chinese population. We therefore aimed to comprehensively investigate epidemiological characteristics of OSL using whole spine CT in the Chinese population and examine the factors that correlate with the presence of OSL. Methods Ossification of the posterior longitudinal ligament (OPLL), ligamentum flavum (OLF), anterior longitudinal ligament (OALL), nuchal ligament (ONL), and diffuse idiopathic skeletal hyperostosis (DISH) were evaluated from the subjects who underwent PET/CT for the purpose of cancer screening in our hospital. Prevalence, distribution, and concomitance of OSL were reviewed. Logistic regression analysis was performed to identify the risk factors of OSL. Results A total of 2000 subjects (1335 men and 665 women) were included. The prevalence rate of cervical OPLL (C-OPLL) was 4.1%, thoracic OPLL (T-OPLL) 2.25%, lumbar OPLL (L-OPLL) 0.8%, thoracic OLF (T-OLF) 37.65%, lumbar OLF (L-OLF) 1.45%, ONL 31.5%, DISH 3.85%. The most commonly involved level was C5 for C-OPLL, T1 for T-OPLL, T10 for T-OLF, and T8/9 for OALL. 21% of subjects with C-OPLL had T-OPLL, 44% of C-OPLL had T-OLF, 38% of T-OPLL had C-OPLL, 53% of T-OPLL had T-OLF, 44% of L-OPLL had T-OPLL, and 56% of L-OPLL had T-OLF. The average age of OSL-positive subjects was significantly higher than that of OSL-negative subjects. The results of the multiple regression analysis revealed that males had a strong association with DISH (odds ratio, 3.15; 95% confidence interval, 1.27–7.78; P = 0.013). Conclusion The prevalence of OSL in the Chinese was revealed. Tandem ossification is not uncommon in people with OSL. There is a high incidence of multiple-regional OPLL in the whole spine. Approximately half of the subjects with OPLL coexist with T-OLF. For patients with clinical symptoms induced by OPLL, thorough evaluation of whole spine using CT is recommended.
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Affiliation(s)
- Haifeng Liang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Building 1, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, F B1, Building 16, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Shunyi Lu
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Building 1, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Shuguang Chen
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, F B1, Building 16, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Dongjie Jiang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Building 1, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, F B1, Building 16, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Qinming Fei
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Building 1, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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98
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García Callejo FJ, Oishi N, López Sánchez I, Pallarés Martí B, Rubio Fernández A, Gómez Gómez MJ. Incidence of diffuse idiopathic skeletal hyperostosis from a model of dysphagia. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:78-82. [PMID: 31122675 DOI: 10.1016/j.otorri.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To relate symptoms of dysphagia to Forestier-Rotes Querol disease or diffuse idiopathic skeletal hyperostosis (DISH), a disorder due to ossification in the anterior longitudinal ligament and calcifications in other entheses. PATIENTS AND METHODS Review of clinical and radiological findings in 455 outpatients attended at our Centre with dysphagia, for 5years, referred from dental, trauma, neurological or primary health care. A diagnosis of DISH was established using Resnick's criteria. RESULTS We detected 51 cases with dysphagia consistent with DISH diagnostic criteria - 11.2% of subjects suffering this symptom- out of 32544 outpatients attended. An incidence of 7:100000 inhabitants per year was observed. Two cases showed significant improvement after removing the new bone in the spine. CONCLUSIONS DISH is an ankylosing ossification between the joints, frequently systemic but showing no clinical symptoms. When symptoms manifest, neck movements and upper airways are involved, mainly dysphagia. A few cases need surgery to relieve the calcification processes.
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Affiliation(s)
- Francisco Javier García Callejo
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España.
| | - Natsuki Oishi
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España
| | - Isabel López Sánchez
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España
| | - Beatriz Pallarés Martí
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España
| | - Andrea Rubio Fernández
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España
| | - María José Gómez Gómez
- Servicio de ORL, Centro de Salud Integrado de Torrente, Consorcio-Hospital General Universitario de Valencia, Torrente, Valencia, España
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99
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Ghammam M, Houas J, Bellakhdher M, Abdelkefi M. Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review. Pan Afr Med J 2019; 32:189. [PMID: 31312301 PMCID: PMC6620073 DOI: 10.11604/pamj.2019.32.189.18561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 11/24/2022] Open
Abstract
Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.
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Affiliation(s)
- Monia Ghammam
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Jihene Houas
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Mouna Bellakhdher
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Mohamed Abdelkefi
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
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100
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Kuperus JS, Oudkerk SF, Foppen W, Mohamed Hoesein FA, Gielis WP, Waalwijk J, Regan EA, Lynch DA, Oner FC, de Jong PA, Verlaan JJ. Criteria for Early-Phase Diffuse Idiopathic Skeletal Hyperostosis: Development and Validation. Radiology 2019; 291:420-426. [PMID: 30938626 DOI: 10.1148/radiol.2019181695] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the formation of new bone along the anterolateral spinal column at four adjacent vertebral bodies. Purpose To propose and validate criteria for the early phase of DISH by using CT data from two large-scale retrospective cohorts, each with 5-year follow-up. Materials and Methods For this retrospective study, CT data at baseline and follow-up in 1367 patients (cohort I) from 2004 to 2011 were evaluated by two observers to define no DISH, early-stage DISH, and definite DISH on the basis of interval development of consecutive complete or incomplete bone bridges. An independent group of 2267 participants from the COPDGene cohort from 2008 to 2016 was used to validate the early DISH criteria (cohort II). The sensitivity and specificity of early DISH criteria were based on findings in the last CT study as the reference standard by using a nested case-control design. κ Values were calculated between seven readers and with a 3-month interval for one reader. Results Cohort I consisted of 100% men, with a mean age of 60.0 years ± 5.6 (standard deviation) and a mean time between baseline and follow-up CT of 5.0 years ± 1.1. Cohort II consisted of 51% men, with a mean age of 59.9 years ± 8.6 and a mean time between baseline and follow-up CT of 5.4 years ± 0.5. In the derivation cohort, 55 patients comprised the early DISH group. Early DISH was defined as the presence of a spinal segment with a complete bone bridge with an adjacent segment of at least a near-complete bone bridge and another adjacent segment with at least the presence of newly formed bone or when three or more adjacent segments were recorded as showing a near-complete bone bridge. In the validation cohort, sensitivity for early DISH (vs no DISH) was 96% (99 of 103 participants; 95% confidence interval [CI]: 90%, 99%). The corresponding specificity was 83% (1695 of 2034 participants; 95% CI: 82%, 85%). The Fleiss κ for interrater reliability was 0.78 (95% CI: 0.77, 0.78), and the κ for intrarater reliability was 0.89 (95% CI: 0.82, 0.96). Conclusion Early diffuse idiopathic skeletal hyperostosis (DISH) criteria had high sensitivity and specificity for predicting the development of DISH. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Block in this issue.
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Affiliation(s)
- Jonneke S Kuperus
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Sytse F Oudkerk
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Wouter Foppen
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Firdaus A Mohamed Hoesein
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Willem Paul Gielis
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Job Waalwijk
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Elizabeth A Regan
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - David A Lynch
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - F Cumhur Oner
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Pim A de Jong
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
| | - Jorrit-Jan Verlaan
- From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.)
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