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Ahmed O, Ramachandran K, Patel Y, Dhanapaul S, Meena J, Shetty AP, Bhari Thippeswamy P, Kanna RM, Rajasekaran S. Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans. Global Spine J 2024; 14:1201-1209. [PMID: 36289007 DOI: 10.1177/21925682221136844] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A Retrospective Study. OBJECTIVE To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions. METHOD A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated. RESULTS Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH. CONCLUSION This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.
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Affiliation(s)
- Owais Ahmed
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Yogin Patel
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Sindhiya Dhanapaul
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Jalaj Meena
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Brikman S, Lubani Y, Mader R, Bieber A. High prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among obese young patients - A retrospective observational study. Semin Arthritis Rheum 2024; 65:152356. [PMID: 38181545 DOI: 10.1016/j.semarthrit.2023.152356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of ligaments and entheses, and most commonly affects the spinal column. The prevalence of DISH is increasing with age and is considered uncommon before the age of 50 years, with an estimated prevalence of less than 5 %. DISH is known to be highly associated with metabolic syndrome and obesity. We aim to assess the prevalence of DISH among young (≤50 yr.) patients suffering from severe obesity (BMI of 35 kg/m2 or higher). METHODS A retrospective analysis assessing chest and spine radiographs (including Computed Tomography, CT) of patients with BMI≥35 visiting the bariatric ambulatory clinic in an academic medical center from 2013 to 2022. Patients included in the analysis were 31-50 years old. Diagnosis of DISH was made according to the Resnick criteria. The prevalence of DISH was calculated. Demographic, clinical and laboratory data were collected and compared between the DISH and non-DISH groups. RESULTS 183 young (mean age: 40.4; 118 females, 64.2 %) obese (BMI median: 40.6; range 35-73) patients were included in the radiographic review. DISH was diagnosed in 33 patients (18.0 %; 95 % CI: 13.1-24.2 %) which was significantly higher than the expected 10 % (Z = 3.62, p<.001); another 8 patients (4.4 %; 95 % CI: 2.2-8.4 %) were considered as "near DISH" (not fulfilling yet the Resnick criteria) as it represents a pre-disease state. Patients diagnosed with DISH were significantly older than patients without DISH (t = 4.54, p<.001), as the prevalence of DISH increased by age (linear association=14.95, p<.001). There was a statistically significantly higher prevalence of hypertension (χ2 = 8.30, p<.004), smoking (χ2 = 4.69, p<.03) and OSA (χ2 = 6.16, p<.013) in the DISH group as compared to their non-DISH counterparts. CONCLUSION The prevalence of DISH among obese young patients was 18 %, which is much higher than in the general population. Early-onset DISH should be regarded as a musculoskeletal obesity-related complication.
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Affiliation(s)
- Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Yazan Lubani
- Internal Medicine C, Emek Medical Center, Afula, Israel
| | - Reuven Mader
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
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Li S, Banno T, Hasegawa T, Yamato Y, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Kurosu K, Nakai K, Matsuyama Y. Long-term effects of diffuse idiopathic skeletal hyperostosis on physical function: A longitudinal analysis. J Orthop Sci 2024; 29:109-114. [PMID: 36669955 DOI: 10.1016/j.jos.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cross-sectional studies on diffuse idiopathic skeletal hyperostosis have focused on its incidence and related factors. However, the long-term changes caused by the disease remain unclear. This longitudinal cohort study aimed to elucidate the progression of diffuse idiopathic skeletal hyperostosis and its effects on physical function, health-related quality of life, and spinal alignment. METHODS We recruited 255 older adults (87 men and 168 women; average age, 71.3 years in 2014) who attended local health checkups in 2014 and 2020. Height, body weight, body mass index, blood pressure, grip strength, functional reach, and bone mineral density were measured. The prevalence, location, number of ossified contiguous vertebrae, and spinopelvic parameters were estimated using whole-spine standing radiographs. For health-related quality of life assessment, the Oswestry disability index and EuroQuol-5D were obtained. We performed a 1:1 case-control study with age and sex-matched patients with and without diffuse idiopathic skeletal hyperostosis and analyzed progression over a 6-year period. RESULTS In 2014, 39 (15.3%) of 255 patients were diagnosed with diffuse idiopathic skeletal hyperostosis (24 males and 15 females), which occurred more frequently in the elderly and males. In 2020, 12 (4.3%) patients were newly diagnosed with diffuse idiopathic skeletal hyperostosis, and 28 (71.7%) of 39 patients diagnosed in 2014 showed varying degrees of progression. Compared with age- and sex-matched patients without diffuse idiopathic skeletal hyperostosis, patients with the condition had higher body mass index and lumbar bone mineral density, larger sagittal vertical axis, and greater T1-pelvic angle. Changes in physical function and spinal-pelvic parameters during the 6-year period did not differ between the groups. CONCLUSIONS Over a 6-year period, the prevalence of diffuse idiopathic skeletal hyperostosis increased by 4.3%, and it progressed in 71.7% of patients. However, it had little effect on longitudinal physical function, health-related quality of life, and spinopelvic parameters in older adults.
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Affiliation(s)
- Shuo Li
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan; Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan; Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keiichi Nakai
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Nagata K, Hashizume H, Oka H, Ishimoto Y, Muraki S, Nakamura K, Yoshida M, Tanaka S, Yamada H, Yoshimura N. Plasma pentosidine concentration is associated with ligament ossification and high-grade osteoarthritis: The ROAD study. Geriatr Gerontol Int 2024; 24:154-160. [PMID: 38031320 DOI: 10.1111/ggi.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
AIM No studies have examined the association between plasma pentosidine levels and ossification diseases in large cohorts of Japanese residents. This study aimed to investigate the association between cervical ossification of the posterior longitudinal ligament (OPLL) and other ossification diseases, including diffuse idiopathic skeletal hyperostosis, lumbar spondylosis and knee osteoarthritis (OA), by examining plain radiographs of the knee, and cervical, thoracic and lumbar spine from 1690 participants, and the association between these diseases and plasma pentosidine. DESIGN We enrolled 1690 participants (596 men and 1094 women) from mountainous and coastal areas from the study population of the previous Research on Osteoarthritis/Osteoporosis Against Disability study. X-ray examination of the cervical/thoracic/lumbar spine and knee was carried out only in these individuals, and not those from urban areas. Plasma pentosidine concentrations were determined using enzyme-linked immunoassays. RESULTS Radiographic OPLL was detected in 30 (17 men, 13 women) of 1562 individuals who underwent X-ray examination of the cervical spine. OPLL, diffuse idiopathic skeletal hyperostosis, lumbar spondylosis Kellgren-Lawrence (KL) grade, and knee OA KL grade were associated with high plasma pentosidine concentrations (all P < 0.05). Furthermore, significant intragroup differences (KL grade 4 vs 3) of plasma pentosidine concentration were observed between the lumbar spondylosis and knee OA groups. The plasma pentosidine concentration was significantly associated with age, OPLL, lumbar spondylosis (KL grade 4) and knee OA (KL grade 4). CONCLUSIONS OPLL is significantly associated with other ossification diseases. The development of more severe OA might lead to the accumulation of plasma pentosidine. Plasma pentosidine levels were associated with OPLL and severe OA. Geriatr Gerontol Int 2024; 24: 154-160.
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Affiliation(s)
- Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Munehito Yoshida
- Department of Orthopedic Surgery, Sumiya Orthopedic Hospital, Wakayama City, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Sun Q, Wang L, Chen X, Zhang Y, Tian Y, Yuan S, Liu X. How Sagittal Spinal Parameters Predict Anterolateral Spinal Ossification Severity: A Study Based on CT Classification. Spine (Phila Pa 1976) 2023; 48:1679-1687. [PMID: 36728011 DOI: 10.1097/brs.0000000000004582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The purpose of this study was to establish a CT classification system of anterolateral spinal ossification and analyze the effects of sagittal spinal parameters on ossification. SUMMARY OF BACKGROUND DATA Patients with diffuse idiopathic skeletal hyperostosis often present with anterolateral ossification of the spine. Few reports consider anterolateral spinal ossification at each spinal level or explore the influence of sagittal alignment. MATERIALS AND METHOD One hundred and twenty patients (79 males and 41 females) over 60 years old who underwent whole spinal CT scans from October 2018 to November 2021 were analyzed. Volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each intervertebral space, and a classification system was established. Sagittal parameters, such as thoracic kyphosis, lumbar lordosis (LL), cervical lordosis, sacral slope, and thoracolumbar junction angle of the patients were measured. Multifactor stepwise linear regression analysis and ordered logistic regression analysis were used to study the effects of the sagittal parameters on ossification grades. RESULTS The median age of the study population was 67 years (63-72 IQR). The new classification system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer intraclass correlation coefficient value of 0.909 and inter-observer intraclass correlation coefficient value of 0.900. Multivariate stepwise linear regression analysis showed that age (OR=1.30, P <0.001), weight (OR=1.23, P =0.013), and cervical lordosis (OR=1.19, P <0.001) were significantly correlated with total ossification grade. Multifactor ordered logistic regression analysis showed that there was a statistically significant correlation between cervical lordosis and the ossification grades of each intervertebral space of T1~T4 ( P ≤0.005), between thoracic kyphosis and each intervertebral space in T4~T12 ( P ≤0.019), and between thoracolumbar junction angle and each intervertebral space in T10~L3 ( P ≤0.025). LL was significantly and positively correlated with the ossification grades of each intervertebral space in T7~T11 ( P ≤0.041). LL and sacral slope were significantly negatively correlated with the ossification grades of each intervertebral space in L3~S1 ( P ≤0.047). CONCLUSION Our new classification scheme demonstrated good accuracy and reliability for the evaluation of the severity of anterolateral spinal ossification. The effect of sagittal parameters on anterolateral spinal ossification was position-specific. The greater the kyphosis or the smaller the lordosis of a spinal region, the more severe the degree of ossification in the corresponding region. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Qingyu Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
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Hirota R, Teramoto A, Yoshimoto M, Takashima H, Yasuda N, Tsukamoto A, Iesato N, Emori M, Iba K, Kawaharada N, Yamashita T. Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2023; 12:5412. [PMID: 37629454 PMCID: PMC10455897 DOI: 10.3390/jcm12165412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH.
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Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0808, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Arihiko Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
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Nishida N, Mumtaz M, Tripathi S, Kumaran Y, Kelkar A, Sakai T, Goel VK. The Effect of Posterior Lumbar Interbody Fusion in Lumbar Spine Stenosis with Diffuse Idiopathic Skeletal Hyperostosis: A Finite Element Analysis. World Neurosurg 2023; 176:e371-e379. [PMID: 37236308 DOI: 10.1016/j.wneu.2023.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Lumbar spinal canal stenosis (LSS) with diffuse idiopathic skeletal hyperostosis (DISH) can require revision surgery because of the intervertebral instability after decompression. However, there is a lack of mechanical analyses for decompression procedures for LSS with DISH. METHODS This study used a validated, three-dimensional finite element model of an L1-L5 lumbar spine, L1-L4 DISH, pelvis, and femurs to compare the biomechanical parameters (range of motion [ROM], intervertebral disc, hip joint, and instrumentation stresses) with an L5-sacrum (L5-S) and L4-S posterior lumbar interbody fusion (PLIF). A pure moment with a compressive follower load was applied to these models. RESULTS ROM of L5-S and L4-S PLIF models decreased by more than 50% at L4-L5, respectively, and decreased by more than 15% at L1-S compared with the DISH model in all motions. The L4-L5 nucleus stress of the L5-S PLIF increased by more than 14% compared with the DISH model. In all motions, the hip stress of DISH, L5-S, and L4-S PLIF had very small differences. The sacroiliac joint stress of L5-S and L4-S PLIF models decreased by more than 15% compared with the DISH model. The stress values of the screws and rods in the L4-S PLIF model was higher than in the L5-S PLIF model. CONCLUSIONS The concentration of stress because of DISH may influence adjacent segment disease on the nonunited segment of PLIF. A shorter-level lumbar interbody fixation is recommended to preserve ROM; however, it should be used with caution because it could provoke adjacent segment disease.
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Affiliation(s)
- Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan.
| | - Muzammil Mumtaz
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, Ohio, USA
| | - Sudharshan Tripathi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, Ohio, USA
| | - Yogesh Kumaran
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, Ohio, USA
| | - Amey Kelkar
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, Ohio, USA
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, Ohio, USA
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Dong Y, Li J, Yang K, Guo S, Zhai J, Zhao Y. Thoracic spondylotic myelopathy in diffuse idiopathic skeletal hyperostosis: a comparative study. J Orthop Surg Res 2023; 18:242. [PMID: 36966324 PMCID: PMC10039576 DOI: 10.1186/s13018-023-03723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND To explore the characteristics and clinical management of thoracic spinal stenosis with diffuse idiopathic skeletal hyperostosis (DISH). METHODS The patients diagnosed with thoracic spondylotic myelopathy who underwent spinal decompression and fusion surgery in a single center between 2012 and 2020 were retrospectively analyzed. All the patients were followed up for at least 2 years. Patients were classified into DISH and non-DISH groups. Demographic, radiographic and clinical parameters were compared between the two groups. RESULTS A total of 100 thoracic spondylotic myelopathy patients were included in the study. 22 patients were diagnosed with DISH. The proportion of male patients in the DISH group was higher, and the average BMI was larger. The incidence of upper thoracic vertebrae with ossification of posterior longitudinal ligament (OPLL) (P < 0.05) and lumbar spine with ossification of ligamentum flavum (OLF) was higher (P < 0.05) in DISH the group. The proportion of patients received staged surgery is higher in the DISH group (P < 0.1). There were no significant differences between the two groups in the amount of surgical bleeding, the ratio of cerebrospinal fluid leakage, the time duration of drainage tube placement and the JOA scores. CONCLUSION Thoracic spinal stenosis with DISH occurred more in male patients with larger BMI. The posterior decompression and fusion surgery could achieve comparable satisfying clinical outcomes between DISH and non-DISH patients. More proportion of patients received staged surgery in the DISH group; the underline mechanism may be DISH caused more OPLL in the upper thoracic spine and more OLF in the lumbar spine because of mechanical stress.
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Affiliation(s)
- YuLei Dong
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jiahao Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Kaili Yang
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Shigong Guo
- Department of Rehabilitation Medicine, Southmead Hospital, Bristol, UK
| | - Jiliang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yu Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China.
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Handa M, Kato S, Sakurai G, Yabe T, Demura S, Takeshita Y, Kanamori T, Nakano Y, Shinmura K, Yokogawa N, Kashihara N, Yahata T, Takamura T, Tsuchiya H. The prevalence of locomotive syndrome and its associated factors in patients with Type 2 diabetes mellitus. Mod Rheumatol 2023; 33:422-427. [PMID: 35107137 DOI: 10.1093/mr/roac004] [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: 09/28/2021] [Revised: 12/14/2021] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients. METHODS Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests). RESULTS The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83-0.94], diabetic retinopathy (OR = 5.85, CI = 1.64-20.78), knee OA (OR = 3.34, CI = 1.11-10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13-10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients. CONCLUSIONS This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.
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Affiliation(s)
- Makoto Handa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Goro Sakurai
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Takuya Yabe
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yumie Takeshita
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takehiro Kanamori
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yujiro Nakano
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoko Kashihara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsutaro Yahata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.,Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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10
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Murakami Y, Morino T, Hino M, Misaki H, Imai H, Miura H. A Scoring System for Anterior Longitudinal Ligament Ossification of the Lumbar Spine in Diffuse Idiopathic Skeletal Hyperostosis: Relationship Between the Extent of Ligament Ossification and the Range of Motion. Global Spine J 2023; 13:378-383. [PMID: 33655763 PMCID: PMC9972288 DOI: 10.1177/2192568221996681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE To investigate the relationship between the extent of ligament ossification and the range of motion (ROM) of the lumbar spine and develop a new scoring system. METHODS Forty-three patients (30 men and 13 women) with lumbar spinal canal stenosis who underwent decompression from January to December 2018. Ligament ossification at L1/2 to L5/S was assessed on plain X-ray (Xp) and computed tomography (CT) using a modified Mata scoring system (0 point: no ossification, 1 point: ossification of less than half of the intervertebral disc height, 2 points: ossification of half or more of the intervertebral disc height, 3 points: complete bridging), and the intra-rater and inter-rater reliability of the scoring was assessed. The relationship of the scores with postoperative lumbar ROM was investigated. RESULT Intra-rater reliability was high (Cronbach's α was 0.74 for L5/S on Xp but 0.8 or above for other sections), as was inter-rater reliability (Cronbach's α was 0.8 or above for all the segments). ROM significantly decreased as the score increased (scores 1 to 2, and 2 to 3). A significant moderate negative correlation was found between the sum of the scores at L1/2-L5/S and the ROM at L1-S (ρ = - 0.4493, P = 0.025). CONCLUSION Our scoring system reflects lumbar mobility and is reproducible. It is effective for assessing DISH in fractures and spinal conditions, and monitoring effects on treatment outcomes and changes over time.
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Affiliation(s)
- Yusuke Murakami
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan,Yusuke Murakami, Department of Orthopedic
Surgery, Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime
791-0295, Japan.
| | - Tadao Morino
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Masayuki Hino
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Misaki
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime
University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
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11
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Singh NA, Shetty AP, Jakkepally S, Kumarasamy D, Kanna RM, Rajasekaran S. Ossification of Posterior Longitudinal Ligament in Cervical Spine and Its Association With Ossified Lesions in the Whole Spine: A Cross-Sectional Study of 2500 CT Scans. Global Spine J 2023; 13:122-132. [PMID: 33567929 PMCID: PMC9837524 DOI: 10.1177/2192568221993440] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To identify the prevalence and characteristics of ossified posterior longitudinal ligament (OPLL) in the cervical spine and its association with other spinal ligament ossifications. METHOD This study is a retrospective review of whole spine CT scans of polytrauma patients from 2009 to 2018. Patients were screened for cervical OPLL (C-OPLL), thoracolumbar OPLL, thoracic ossified ligamentum flavum (OLF), cervical and thoracolumbar ossified anterior longitudinal ligament (C-OALL AND T-L OALL), ossified nuchal ligament (ONL) and, diffuse idiopathic skeletal hyperostosis (DISH) using CT scans. Their prevalence and distributions were assessed using statistical tools. Chi-square tests were used to determine statistical association between the categorical parameters. RESULTS Out of 2500 patients, 128 had C-OPLL with a prevalence rate of 5.12% with mean age of 55.89 year. The most commonly affected level was C5, followed by C6, and C4. The segmental OPLL was highest in number (77.7%), followed by localized type (14.8%). While the prevalence rate of thoracic OPLL was 0.56%, OLF was 9.9%. Ossifications that coexisted along with C-OPLL were thoracic OPLL (7.81%), thoracic OLF (36.71%), cervical OALL (29.68%), thoracolumbar OALL (37.5%), DISH (27.34%) and, ONL (7.03%). CONCLUSION Our study indicated a prevalence rate of 5.12% for C-OPLL with a predominance of segmental OPLL (77.7%). Among these patients, approximately 36% had coexisting thoracic OLF. In patients with symptomatic OPLL induced cervical myelopathy, MRI analysis of whole spine with relevant CT correlation may help in detecting additional ossification sites of compression.
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Affiliation(s)
| | - Ajoy Prasad Shetty
- Orthopaedic and Spine Surgery, Ganga
Hospital, Coimbatore, Tamil Nadu, India,Ajoy Prasad Shetty, MS, DNB (Orthopedics),
Orthopedic and Spine Surgeon, Ganga Hospital, 313, Mettupalayam Road, Coimbatore
641043, Tamil Nadu, India.
| | | | - Dinesh Kumarasamy
- Orthopaedic and Spine Surgery, Ganga
Hospital, Coimbatore, Tamil Nadu, India
| | - Rishi Mukesh Kanna
- Orthopaedic and Spine Surgery, Ganga
Hospital, Coimbatore, Tamil Nadu, India
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12
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A case of diffuse idiopathic hyperostosis of bone (DISH) in a patient on hemodialysis. CEN Case Rep 2022; 12:226-229. [PMID: 36401745 PMCID: PMC10151430 DOI: 10.1007/s13730-022-00755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory progressive disease resulting in ossification of the anterior longitudinal ligament of the spine and tendons. Herein, we describe a case of DISH in a patient on long-term hemodialysis. The patient was a 79-year-old man undergoing hemodialysis for chronic kidney disease due to diabetic nephropathy. He presented to the emergency department complaining of back pain after a slip and fall. Radiographs revealed bamboo spine-like findings, extending from the cervical to the lumbar spine. Computed tomography and magnetic resonance imaging revealed a compression fracture of thoracic vertebra 12, with abnormal ossification of the anterior longitudinal ligament. Inter-vertebral vertical osseous bridges were also observed at the cervical 7 and lumbar 2 vertebrae. There was no obvious spinal cord compression. Leukocytosis and C-reactive protein levels were not elevated and the human leukocyte type antigen HLA-B27 test was negative. Based on this finding, a diagnosis of DISH was made. In the absence of neurological findings, the patient was treated conservatively. Our findings show an overlap between the clinical features of DISH and those of hemodialysis patients, including older age, male sex, and diabetes.
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13
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Ciaffi J, Borlandelli E, Visani G, Facchini G, Miceli M, Ruscitti P, Cipriani P, Giacomelli R, Ursini F. Prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in Italy. Radiol Med 2022; 127:1159-1169. [PMID: 36057932 PMCID: PMC9512867 DOI: 10.1007/s11547-022-01545-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Purpose Diffuse idiopathic skeletal hyperostosis (DISH) is a benign condition characterized by ossification of the spine and prominent enthesopathies. Highly heterogeneous epidemiological figures have been reported in the literature, while in Italy the largest study has been conducted in 1992. The aim of our research is to contribute updated information about prevalence of DISH in Italy and to describe the clinical and radiographic characteristics associated with the disorder. Material and methods A retrospective review of lumbosacral spine, thoracic spine and pelvis radiographs was performed. Consecutive patients visiting the emergency department of our Institution over 3 years were enrolled. Presence of DISH was evaluated applying the Resnick and Niwayama criteria. Clinical and radiological features were also assessed. Results We included 1012 individuals (60.6% women), and DISH was present in 130 cases. The overall prevalence of DISH was 12.8% (95% CI 10.8–15.1), with higher figures in the male sample (16.8%) than in females (10.3%). In binary logistic regression adjusted for age, BMI (OR 1.50, p < 0.001) diabetes (OR 1.85, p = 0.003), hypertension (OR 2.04, p = 0.007) ischiopubic enthesopathy (OR 7.08, p < 0.001), iliac crest enthesopathy (OR 4.63, p < 0.001) and greater trochanter enthesopathy (OR 3.51, p < 0.001), were significantly associated with the condition. Conclusion The prevalence of DISH observed in our study is consistent with previous literature, and we confirm that the disorder is more frequently retrieved in men and that it is associated with the presence of metabolic disorders and pelvic enthesopathy. Knowledge about the epidemiology and characteristics of DISH is needed to properly identify the condition.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Elena Borlandelli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Gaia Visani
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Giacomelli
- Rheumatology and Immunology Unit, Department of Medicine, University of Rome Campus Biomedico, Rome, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40125, Bologna, Italy.
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14
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Prognostic Factors and Optimal Surgical Management for Lumbar Spinal Canal Stenosis in Patients with Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2022; 11:jcm11144133. [PMID: 35887897 PMCID: PMC9323686 DOI: 10.3390/jcm11144133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
Lumbar spinal canal stenosis (LSS) and diffuse idiopathic skeletal hyperostosis (DISH) tend to develop in the elderly, resulting in an increased need for lumbar surgery. However, DISH may be a risk factor for poor clinical outcomes following lumbar decompression surgery, especially in patients with DISH extending to the lumbar segment (L-DISH). This study aimed to identify the prognostic factors of LSS with L-DISH and propose an optimal surgical management approach to improve clinical outcomes. Of 934 patients who underwent lumbar decompression surgery, 145 patients (15.5%) had L-DISH. In multivariate linear regression analysis of the JOA score improvement rate, the presence of vacuum phenomenon at affected segments (estimate: −15.14) and distance between the caudal end of L-DISH and decompressed/fused segments (estimate: 7.05) were independent prognostic factors. In logistic regression analysis of the surgical procedure with JOA improvement rate > 25% in L-DISH patients with both negative prognostic factors, the odds ratios of split laminotomy and short-segment fusion were 0.64 and 0.21, respectively, with conventional laminotomy as the reference. Therefore, to achieve better clinical outcomes in cases with decompression at the caudal end of L-DISH, decompression surgery without fusion sparing the osteoligamentous structures at midline should be considered as the standard surgery.
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15
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Zhang B, Chen G, Chen X, Chen Z, Sun C. Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071652. [PMID: 35885556 PMCID: PMC9324076 DOI: 10.3390/diagnostics12071652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been evaluated as a potential risk factor of poor surgical outcomes for lumbar spinal stenosis, whereas the influence of DISH on neuroimaging characteristics and postoperative prognosis of patients with thoracic myelopathy has not been established. Therefore, this study aimed to shed light on this issue. Methods: A monocentric study enrolled 167 eligible patients with thoracic ossification of ligamentum flavum (TOLF), who were followed up for at least 2 years. Clinico-radiological parameters and surgical outcomes were compared between the DISH+ and DISH− groups before and after propensity matching. Subgroup analysis was conducted to compare the functional outcomes between mild DISH (M-DISH) and moderately severe DISH (MS-DISH) groups. Results: Fifty-eight patients were diagnosed as DISH, and its prevalence was 34.7%. Patients with DISH presented with older age, more males, taller stature, heavier weight, more commonly diffuse-type TOLF (p < 0.05). The DISH group showed significantly worse recovery rate (RR) at the final follow-up before and after propensity matching (p < 0.01), and slightly lower preoperative VAS, higher postoperative VAS and lower VAS reduction, despite not reaching the significant differences. Subgroup analysis demonstrated that the M-DISH group was associated with the lower mJOA score (p = 0.01) and RR at the final follow-up (p = 0.001), and tended to present higher preoperative VAS than the MS-DISH group. Conclusions: DISH has a significant predisposition to the elderly males with diffuse-type TOLF. Although the presence of M-DISH might bring about a suboptimal surgical outcome, both DISH and non-DISH patients experienced good neurological function improvements and pain relief through thoracic posterior decompression.
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Affiliation(s)
- Baoliang Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Xi Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
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16
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Ikuma H, Hirose T, Nakamura D, Yamashita K, Ueda M, Sasaki K, Kawasaki K. The Prevalence and Characteristics of Diffuse Idiopathic Skeletal Hyperostosis (DISH): A Cross-Sectional Study of 1519 Japanese Individuals. Diagnostics (Basel) 2022; 12:diagnostics12051088. [PMID: 35626245 PMCID: PMC9140032 DOI: 10.3390/diagnostics12051088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a pathology characterized by enthesis ossification, but there have been few reports on epidemiological surveys. This report presents a cross-sectional survey of DISH from thoracic to sacral spine in patients at the tertiary emergency medical center. Methods: The patients were divided into DISH (+) group and DISH (−) group for a retrospective comparative study. The primary outcome measures were the frequency of DISH and the patient demographic data, the secondary outcome measures were the previous medical history (diabetes mellitus, cardiovascular disease), the extent of aortic calcification, the frequency of hyperostosis around the costovertebral joint and the mortality rate within 3 months of the initial examination. Results: This survey examined a total of 1519 patients. There were 265 cases (17.4%) in the DISH (+) group and 1254 cases in DISH (−) group. The prevalence of DISH was concentrated at the thoracolumbar junction, particularly at T9. The mean age, ratio of male and hyperostosis around the costovertebral joint were significantly higher in the DISH (+) group (p < 0.001), but there was no significant difference in other variables. Conclusions: The pathology of DISH might involve the effects of age-related changes or biomechanical effects.
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Affiliation(s)
- Hisanori Ikuma
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
- Correspondence: ; Tel.: +81-87-811-3333
| | - Tomohiko Hirose
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Dai Nakamura
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Kazutaka Yamashita
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Masataka Ueda
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
| | - Kazuhiro Sasaki
- Department of Emergency and Critical Care Medicine, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan;
| | - Keisuke Kawasaki
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, 2-1, Asahi-Machi 1-Chome, Takamatsu 760-8557, Japan; (T.H.); (D.N.); (K.Y.); (M.U.); (K.K.)
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17
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Misaki H, Morino T, Hino M, Murakami Y, Imai H, Miura H. Can Diffuse Idiopathic Skeletal Hyperostosis Be Diagnosed by Plain Lumbar Spine X-Ray Findings Alone? Global Spine J 2022; 12:198-203. [PMID: 35253462 PMCID: PMC8907637 DOI: 10.1177/2192568220948038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To determine whether diffuse idiopathic skeletal hyperostosis (DISH) can be diagnosed based on anterior longitudinal ligamental ossification in the lumbar spine using plain lumbar spine X-ray images. METHODS This study included 100 patients (59 men and 41 women; mean age, 64.8 ± 13.8 years; range, 27-89 years) who underwent computed tomography (CT) of the chest to the pelvis in our hospital and plain lumbar spine radiography within 6 months before and after CT scanning. DISH was diagnosed based on the thoracolumbar spine CT findings using Resnick's diagnostic criteria. The patients were grouped according to DISH diagnosis into the DISH (+) and DISH (-) groups. On the frontal and lateral lumbar spine X-ray images, each spinal level from Th11/12 to L5/S was scored based on the Mata scoring system. The distribution of the Mata scores was compared between the 2 groups. RESULTS Forty (40%) patients were diagnosed with DISH based on the CT findings. A cutoff value ≥8 provided a sensitivity of 75% and specificity of 100% for diagnosing DISH, thus, indicating the validity of the cutoff value. In the DISH (-) group, no patient had ≥3 consecutive spinal levels with a Mata score ≥2, suggesting that DISH can be diagnosed on the basis of at least 3 consecutive spinal levels with a Mata score ≥2. CONCLUSION On lumbar spine X-ray images of the T11/12 to L5/S levels, a Mata score ≥2 for at least 3 consecutive levels or a total score ≥8 strongly indicates the presence of DISH.
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Affiliation(s)
- Hiroshi Misaki
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Tadao Morino
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan,TadaoMorino, Department of Orthopedic
Surgery, Ehime University, Shitsukawa, Tohon City, Ehime 791-0295, Japan.
| | - Masayuki Hino
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Yusuke Murakami
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University, Shitsukawa, Tohon City, Ehime, Japan
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18
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Penetrating Endplate Screw Fixation for Thoracolumbar Pathological Fracture of Diffuse Idiopathic Skeletal Hyperostosis. Case Rep Orthop 2022; 2022:5584397. [PMID: 35251727 PMCID: PMC8894060 DOI: 10.1155/2022/5584397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/20/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
With the advancement of cancer treatment and minimally invasive surgery, the indications for surgery for metastatic spinal tumors are expanding. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory skeletal disease characterized by calcification and ossification of ligaments and entheses. In Japan, the prevalence of DISH is increasing with its superaging society. The purpose of this article is to report a case of applying a novel screw technique for pathological fracture in a patient with DISH and spinal metastasis. An 80-year-old man with spinal metastasis presented with acute onset of severe back pain, and investigations revealed a fracture of a metastatic lesion in T10–T12 in the range of DISH. We performed posterior fixation with a percutaneous pedicle screw system using a penetrating endplate technique. The patient's back pain improved, and he was able to mobilize with minimal assistance and survived for 8 months with a good quality of life. Spinal fracture accompanied by DISH sometimes occurs with severe instability because of injury across 3-column injury and its long lever arm. Spinal instability neoplastic score indicates instability of pathological fractures of spinal metastases but needs to be evaluated carefully when DISH is present. The prevalence of DISH is increasing in the elderly, and penetrating endplate screws can be an effective option in posterior fusion surgery for patients with DISH and spinal metastases.
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19
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Akiyama S, Tanaka T, Udaka J, Inagaki N, Kumagae Y, Chazono M, Matsuoka T, Saito M. Factors affecting spine–femur discordance in the percentage of young adult mean on dual-energy X-ray absorptiometry in the elderly population: a retrospective study. BMC Musculoskelet Disord 2022; 23:76. [PMID: 35062924 PMCID: PMC8783505 DOI: 10.1186/s12891-022-05015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Several retrospective studies have reported spine–femur discordance in bone mineral density (BMD) values. However, the average age of individuals in these studies was the mid-50s, which is younger than the typical age of individuals requiring treatment for primary osteoporosis. Therefore, we aimed to investigate factors associated with discordance in the percentage of young adult mean (YAM) between the lumbar spine and femoral neck in the elderly population. Methods We evaluated 4549 dual-energy X-ray absorptiometry (DXA) measurements obtained from 2161 patients (269 men and 1892 women) between January 2014 and December 2017 at our hospital. For individuals with more than one eligible set of measurements, the first record was used. We investigated each patient’s age, sex, body mass index, current smoking status, alcohol consumption, use of steroids, presence of diabetes mellitus, and presence of rheumatoid arthritis. Results The mean age of the patients was 76.4 ± 8.9 years. Older age (p < 0.001), male sex (p < 0.001), and diabetes mellitus (p = 0.007) were significantly associated with spine–femur discordance in the percentage of YAM. Conclusion The frequency and magnitude of spine–femur discordance in the percentage of YAM from DXA scans increased with age. Notably, more than 77.4% of patients in their 90s had spine–femur discordance > 10% of YAM. Furthermore, the frequency of spine–femur discordance was higher in men and in patients with diabetes mellitus, suggesting that the percentage of YAM at the lumbar spine may not be reliable for diagnosis of osteoporosis in patients with these factors.
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OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:3981-3988. [DOI: 10.1093/rheumatology/keac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/19/2022] [Indexed: 11/12/2022] Open
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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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Kobayashi K, Okada E, Yoshii T, Tsushima M, Yamada T, Watanabe K, Katsumi K, Hiyama A, Katoh H, Watanabe M, Nakagawa Y, Okada M, Endo T, Shiraishi Y, Takeuchi K, Matsunaga S, Maruo K, Sakai K, Kobayashi S, Ohba T, Wada K, Ohya J, Mori K, Nishimura H, Tsuji T, Watanabe K, Okawa A, Matsumoto M, Imagama S. Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey. J Orthop Sci 2021; 26:968-973. [PMID: 33334624 DOI: 10.1016/j.jos.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH). METHODS The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury. RESULTS Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis. CONCLUSION In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan; Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan
| | - Eijiro Okada
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Toshitaka Yoshii
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan
| | - Mikito Tsushima
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, 455-8530, Aichi, Japan
| | - Tsuyoshi Yamada
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan
| | - Kei Watanabe
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan
| | - Keiichi Katsumi
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan
| | - Akihiko Hiyama
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan
| | - Hiroyuki Katoh
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan
| | - Masahiko Watanabe
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan
| | - Yukihiro Nakagawa
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, 649-7113, Wakayama, Japan
| | - Motohiro Okada
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Wakayama, Japan
| | - Teruaki Endo
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan
| | - Yasuyuki Shiraishi
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan
| | - Kazuhiro Takeuchi
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Okayama, Japan
| | - Shunji Matsunaga
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, 892-8502, Kagoshima, Japan
| | - Keishi Maruo
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Kenichiro Sakai
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, 332-8558, Saitama, Japan
| | - Sho Kobayashi
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Higashi Ward, Hamamatsu, 432-8580, Shizuoka, Japan
| | - Tetsuro Ohba
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898, Yamanashi, Japan
| | - Kanichiro Wada
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, 036-8562, Aomori, Japan
| | - Junichi Ohya
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Kanji Mori
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan
| | - Hirosuke Nishimura
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, 160-8402, Tokyo, Japan
| | - Takashi Tsuji
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, 152-8902, Tokyo, Japan
| | - Kota Watanabe
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Atsushi Okawa
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan
| | - Morio Matsumoto
- Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan; Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.
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Nakajima H, Honjoh K, Watanabe S, Kubota A, Matsumine A. Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment. J Neurosurg Spine 2021:1-7. [PMID: 34653984 DOI: 10.3171/2021.5.spine21412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH. METHODS A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors' hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups. RESULTS L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery. CONCLUSIONS The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.
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Association between Severity of Diffuse Idiopathic Skeletal Hyperostosis and Ossification of Other Spinal Ligaments in Patients with Ossification of the Posterior Longitudinal Ligament. J Clin Med 2021; 10:jcm10204690. [PMID: 34682814 PMCID: PMC8539272 DOI: 10.3390/jcm10204690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/09/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Although diffuse idiopathic skeletal hyperostosis (DISH) is known to coexist with the ossification of spinal ligaments (OSLs), details of the radiographic relationship remain unclear. Methods: We prospectively collected data of 239 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) and analyzed the DISH severity on whole-spine computed tomography images, using the following grades: grade 0, no DISH; grade 1, DISH at T3–T10; grade 2, DISH at both T3–T10 and C6–T2 and/or T11–L2; and grade 3, DISH beyond C5 and/or L3. Ossification indices were calculated as the sum of vertebral and intervertebral levels with OSL for each patient. Results: DISH was found in 107 patients (44.8%), 65 (60.7%) of whom had grade 2 DISH. We found significant associations of DISH grade with the indices for cervical OPLL (r = 0.45, p < 0.0001), thoracic ossification of the ligamentum flavum (OLF; r = 0.41, p < 0.0001) and thoracic ossification of the supra/interspinous ligaments (OSIL; r = 0.53, p < 0.0001). DISH grade was also correlated with the index for each OSL in the whole spine (OPLL: r = 0.29, p < 0.0001; OLF: r = 0.40, p < 0.0001; OSIL: r = 0.50, p < 0.0001). Conclusion: The DISH grade correlated with the indices of OSL at each high-prevalence level as well as the whole spine.
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Clavaguera T, Reyner P, Buxó M, Valls M, Armengol E, Juanola X. Identifying Clinicoradiological Phenotypes in Diffuse Idiopathic Skeletal Hyperostosis: A Cross-Sectional Study. Medicina (B Aires) 2021; 57:medicina57101005. [PMID: 34684042 PMCID: PMC8538653 DOI: 10.3390/medicina57101005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is a bone formation disease in which only skeletal signs are considered in classification criteria. The aim of the study was to describe different phenotypes in DISH patients based on clinicoradiological features. Materials and Methods: We evaluated 97 patients who met the Resnick or modified Utsinger classification criteria for DISH and were diagnosed at our hospital from 2004 to 2015. Patients were stratified into: (a) peripheral pattern (PP)—Resnick criteria not met but presenting ≥3 peripheral enthesopathies; (b) axial pattern (AP)—Resnick criteria met but <3 enthesopathies; and (c) mixed pattern (MP)—Resnick criteria met with ≥3 enthesopathies. Statistical analysis was carried out to identify variables that might predict classification in a given group. Results: Fifty-six of the 97 patients included (57.7%) were male and 72.2% fulfilled the Resnick criteria. Applying our classification, 39.7% were stratified as MP, 30.9% as AP and 29.4% as PP. Clinical enthesopathy was reported in 40.2% of patients during the course of the disease. Sixty-eight patients were included in a comparative analysis of variables between DISH patterns. The results showed a predominance of women (p < 0.004), early onset (p < 0.03), hip involvement (p < 0.003) and enthesitis (p < 0.001) as hallmarks of PP. Asymptomatic patients were most frequently observed in AP (28.6%, MP 3.8%, PP 5.0%) while MP was characterized by a more extensive disease. Conclusions: We believe DISH has distinct phenotypes and describe a PP phenotype that is not usually considered. Extravertebral manifestations should be included in the new classification criteria in order to cover the entire spectrum of the disease.
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Affiliation(s)
- Teresa Clavaguera
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
- Correspondence: or ; Tel.: +34-972-94-02-00
| | - Patrícia Reyner
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
| | - Maria Buxó
- Servei de Biostadística, Institut d’Investigació Biomèdica de Girona (IDIBGI), 17003 Girona, Spain;
| | - Marta Valls
- Servei de Reumatologia, Hospitals Universitari Josep Trueta i Hospital, Santa Caterina, 17007 Salt, Spain; (P.R.); (M.V.)
| | | | - Xavier Juanola
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain;
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Visceral Adipose Tissue and Different Measures of Adiposity in Different Severities of Diffuse Idiopathic Skeletal Hyperostosis. J Pers Med 2021; 11:jpm11070663. [PMID: 34357130 PMCID: PMC8305748 DOI: 10.3390/jpm11070663] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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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Murakami Y, Morino T, Hino M, Misaki H, Miura H. Progression of Ossification of the Anterior Longitudinal Ligament Associated With Diffuse Idiopathic Skeletal Hyperostosis by Age: A Study of Computed Tomography Findings Over 5 Years. Global Spine J 2021; 11:656-661. [PMID: 32875895 PMCID: PMC8165915 DOI: 10.1177/2192568220918817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE To investigate whether the progression of anterior longitudinal ligament ossification varies by age among patients with diffuse idiopathic skeletal hyperostosis (DISH). METHODS Of the patients who underwent computed tomography (CT) of the thoracic to pelvic region at least twice from 2009 to 2018, 191 who underwent CT at an interval of 5 years and 0 months to 5 years and 2 months were enrolled (87 men and 104 women). Sex, age at the time of the first CT scan, the presence/absence of DISH, level of complete vertebral body fusion associated with DISH, and extent of ligament ossification using the modified Mata scoring system were investigated. RESULTS DISHs were detected in 53 (27.7%) of 191 patients. The score of ligament ossification increased over time in 35 (66%) of 53 patients; 93 intervertebral spaces were affected. The percentage of completely fused intervertebral spaces increased by 6.7% from 31.3% to 38.0% over time. The increase in score for all intervertebral spaces in individual patients was significantly greater in the ≤70 years old group (2.7 ± 2.8 points, n = 28) than in the ≥71 years old group (1.2 ± 1.4 points; n = 25; P = .028). The mean age of patients with a recorded score that increased by ≥1 point was 67.4 years and that of patients without any change in the score was 73.3 years (P = .036). Thus, patients with recorded changes in the score were younger. CONCLUSION During the approximately 5-year period, ossification progressed more in younger patients than in older patients.
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Affiliation(s)
- Yusuke Murakami
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan,Yusuke Murakami, Department of Orthopedic Surgery, Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime 791-0295, Japan.
| | - Tadao Morino
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Masayuki Hino
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiroshi Misaki
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
| | - Hiromasa Miura
- Ehime University School of Medicine, Shitsukawa, Tohon City, Ehime, Japan
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Pathomechanism and prevention of further surgery after posterior decompression for lumbar spinal canal stenosis in patients with diffuse idiopathic skeletal hyperostosis. Spine J 2021; 21:955-962. [PMID: 33453385 DOI: 10.1016/j.spinee.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery after posterior decompression without fusion for patients with lumbar spinal canal stenosis (LSS). However, a strategy to prevent revision surgery has not been described. PURPOSE The aim of this study was to review clinical and imaging findings in LSS patients with DISH extending to the lumbar segment and to propose countermeasures for prevention of revision surgery. STUDY DESIGN A retrospective study. PATIENTS SAMPLE A total of 613 consecutive patients with LSS underwent posterior decompression without fusion at our hospital and had a minimum follow-up period of 2 years. We defined patients with DISH bridging to the lumbar segment as L-DISH cases (group D, n=111), and those without as non-L-DISH cases (group N, n=502). OUTCOME MEASURE Demographic data including the rate of revision surgery, neurological examination using Japanese Orthopaedic Association score, radiological studies comprised plain lumbar radiography, CT, and high-resolution MRI were assessed. METHODS Clinical features and imaging findings were compared in patients with and without L-DISH. Revision surgery and surgical procedures (conventional laminotomy or lumbar spinous process-splitting [split] laminotomy) were examined in the two groups. No funding was received for this study. RESULTS L-DISH from L2 to L4 was a risk factor for disc degeneration such as a vacuum phenomenon and for further surgical treatment. The rate of revision surgery was higher in group D than in group N (9.0% vs. 4.0%, p=.026). There was no significant difference in this rate for patients in groups D and N who underwent conventional laminotomy; however, for those who underwent split laminotomy, the rate was significantly higher in group D (16.7% vs. 2.1%, p=.0006). Furthermore, the rate of revision surgery after split laminotomy at a lower segment adjacent to L-DISH was significantly higher than that after conventional laminotomy (37.5% vs. 7.7%, p=.037). CONCLUSIONS A negative impact of lumbar spinous process-splitting laminotomy was found, especially with decompression at a lower segment adjacent to L-DISH. In such cases, surgery sparing the osteoligamentous structures at midline, including the spinous process and supra- and interspinous ligaments, should be selected.
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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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Hishiya T, Ishikawa T, Ota M. Posterior spinal fixation using penetrating endplate screws in patients with diffuse idiopathic skeletal hyperostosis-related thoracolumbar fractures. J Neurosurg Spine 2021:1-6. [PMID: 33836499 DOI: 10.3171/2020.10.spine201387] [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: 07/27/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures essentially require operative treatment due to severe fracture site instability and high potential risk of posttraumatic neurological deficit. However, the optimal surgical procedure remains unclear. The purpose of this study was to assess the efficacy of posterior spinal fixation with penetrating endplate screws (PESs) for DISH-related thoracolumbar fractures. METHODS The authors conducted a retrospective, single-center, observational study. They included data from 26 consecutive patients with DISH-related thoracolumbar fractures who were treated with posterior spinal fixation using either conventional pedicle screws (PS group, n = 8) or a combined PES technique (PES group, n = 18) between 2013 and 2019. Age, sex, BMI, bone mineral density, fracture level, use of antithrombotic drug, blood loss, operation time, fixation range, perioperative American Spinal Injury Association Impairment Scale score, implant failure, revision surgery, complications, and mortality were compared. The authors also evaluated screw loosening and bone healing on radiographs and CT scans. RESULTS More patients had vertebral fractures in the lumbar spine in the PS group than in the PES group (3 vs 0; p = 0.019). Patients in the PES group had less blood loss (63 vs 173 ml; p = 0.048) and shorter range of fixation (5 vs 5.5 levels; p = 0.041). The screw loosening rate was significantly lower in the PES group than in the PS group (3% vs 49%; p < 0.001). CONCLUSIONS Posterior spinal fixation using a PES technique may be an ideal surgical procedure for thoracolumbar fractures with DISH, providing more rigid and less invasive fixation than PS.
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Affiliation(s)
- Takahisa Hishiya
- 1Orthopedic Surgery, Sanmu Medical Center, Chiba, Japan; and.,2Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Mitsutoshi Ota
- 1Orthopedic Surgery, Sanmu Medical Center, Chiba, Japan; and
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Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography. BMC Musculoskelet Disord 2021; 22:55. [PMID: 33422036 PMCID: PMC7797098 DOI: 10.1186/s12891-020-03916-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.
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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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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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Differences in Bone Mineral Density and Bone Turnover Markers Between Subjects With and Without Diffuse Idiopathic Skeletal Hyperostosis. Spine (Phila Pa 1976) 2020; 45:E1677-E1681. [PMID: 32925682 DOI: 10.1097/brs.0000000000003689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Japanese resident cohort study based on a municipal registry. OBJECTIVE This study of a community-dwelling elderly Japanese population employed random sampling from the basic resident registry of a rural town for subject selection to investigate the differences in bone mineral density (BMD) and bone turnover markers between subjects with and without diffuse idiopathic skeletal hyperostosis (DISH). SUMMARY OF BACKGROUND DATA DISH is a condition characterized by the calcification and ossification of soft tissues. Although some reports have addressed BMD in DISH, the precise status of BMD and bone metabolism in individuals with DISH remains unclear. METHODS Eight groups based on age (50s, 60s, 70s, and 80s) and sex after random sampling from the resident registry of Obuse town were established. A total of 411 participants (202 males and 209 females) were enrolled for the evaluation of BMD and bone turnover markers. All subjects underwent a single whole-spine lateral radiographic examination for the existence of DISH. The BMD and bone turnover markers of subjects with and without DISH were analyzed for associations with the disorder using multivariate analysis. RESULTS DISH was detected in 66 (16.1%) participants in our population cohort. According to multivariate analysis, increased lumbar and hip BMD were significantly related to DISH (odds ratio: 7.47 and 22.8, respectively). CONCLUSION This study clarified the differences in BMD and bone turnover markers between subjects with and without DISH on a general population basis. Multivariate analysis revealed increased lumbar and hip BMD to be significantly associated with DISH, with no remarkable findings for bone turnover markers. LEVEL OF EVIDENCE 4.
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Watanabe D, Takano H, Kimura T, Yamashita A, Minowa T, Mizushima A. The relationship of diffuse idiopathic skeletal hyperostosis, visceral fat accumulation, and other age-related diseases with the prevalent vertebral fractures in elderly men with castration-naïve prostate cancer. Aging Male 2020; 23:1512-1517. [PMID: 33191830 DOI: 10.1080/13685538.2020.1815694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in prostate cancer patients and its relationship with prevalent vertebral fractures (PVF) has not yet been demonstrated. This study aimed to investigate the relationship of DISH, visceral fat accumulation, and other age-related diseases to PVF in elderly men with castration-naïve prostate cancer (CNPC). A total of 134 CNPC patients who were ≥65 years of age without bone metastases were registered in this study. DISH was found in 36.6% (49/134) of the patients in the study population. Patients with DISH were significantly older and had a lower total hip-bone mineral density (BMD) than those without DISH. On the other hand, there were no significant differences in fat distribution, prevalence of hypertension, dyslipidemia, diabetes, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c, prostate-specific antigen (PSA), or lumbar-BMD (L-BMD). A multivariate analysis of age, DISH, body mass index (BMI), visceral fat area (VFA), and total hip-BMD, which were significantly associated with PVF in a univariate analysis, showed that age (OR 1.11; p = .02) and DISH (OR 5.99; p = .0003) were independently associated with PVF. This study suggests that the presence of DISH may not be negligible when assessing the risk of vertebral fracture in prostate cancer patients before treatment.
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Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Koto Hospital, Tokyo, Japan
| | - Hiromitsu Takano
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Okada E, Ishihara S, Azuma K, Michikawa T, Suzuki S, Tsuji O, Nori S, Nagoshi N, Yagi M, Takayama M, Tsuji T, Fujita N, Nakamura M, Matsumoto M, Watanabe K. Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis. Neurospine 2020; 18:109-116. [PMID: 33211945 PMCID: PMC8021843 DOI: 10.14245/ns.2040350.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome. METHODS We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated. RESULTS Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0-3.7; p = 0.004). CONCLUSION Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.
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Affiliation(s)
- Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Shinichi Ishihara
- Keio Spine Research Group, Tokyo, Japan.,Department of Orthopaedic Surgery, Ota Memorial Hospital, Oshimasho, Ota City, Japan
| | - Koichiro Azuma
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, Toho University, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Takashi Tsuji
- Keio Spine Research Group, Tokyo, Japan.,Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nobuyuki Fujita
- Keio Spine Research Group, Tokyo, Japan.,Department of Orthopaedic Surgery, Fujita Health University, Toyoake-shi, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group, Tokyo, Japan
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Huang C, Zhang Z, Chen Y, Zhang Y, Xing D, Zhao L, Lin J, Mei Y, Lin HY, Zheng Y, Tsai WC, Liu S, Jiang Q, Liu Y, Chen J, Ye Z, Chen M, Chen Y, Chu CQ, Gao M, He L, Lin J, Wu L, Xu J, Yang P, Zhang X, Jiang Q, Lei G, Li M, Yang W, Gu X, Zhou Y, He D, Liu W, Zhang W, Ding C, Zeng X. Development and formulation of the classification criteria for osteoarthritis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1068. [PMID: 33145287 PMCID: PMC7575945 DOI: 10.21037/atm-20-4673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The classification criteria of osteoarthritis (OA) is lack of the support of relevant research evidence and there is no standardized protocol for detailed steps of the development or clinical verification of classification criteria has yet been established. This study aims to describe the development process of the Categorization of Osteoarthritis CHecklist (COACH), which is designed to choose the precise treatment option for patients with OA. Methods A multidisciplinary panel was established to gather opinions. We conducted questionnaire survey and literature review to generate and COACH Panel members were invited to review the drafted classification criteria and optimize classification criteria. The final list of items was discussed and reached the agreement by the core group of the panel. Results Thirty-six experts participated in COACH Panel including rheumatologist (80.6%; 29/36), orthopedist (13.9%; 5/36), methodologist (2.8%; 1/36) and rehabilitation physician (2.8%; 1/36) for classification factors generating and optimizing. The main body of the final classification criteria consists of six types of OA pathogenesis, eight types of medical findings (which can be grouped into two categories), and six types of the location. The final criteria include load-based type, structure-based type, inflammation-based type, metabolic-based type, systemic factor based type and mixed type. Conclusions COACH can better help clinicians quickly classify OA patients and help to choose the best treatment option from the aspects of types, findings and locations. What’s more, the classification criteria are also helpful to promote the basic medical research and targeted prevention of OA.
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Affiliation(s)
- Cibo Huang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyi Zhang
- Department of Rheumatology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Yue Zhang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China
| | - Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China
| | - Like Zhao
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China
| | - Yifang Mei
- Department of Rheumatology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hsiao-Yi Lin
- Veterans General Hospital, Taipei and National Yang-Ming Medical University, Taipei, Taiwan
| | - Yi Zheng
- Department of Rheumatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Chung Tsai
- Department of Internal Medicine, Kaohsiung Medical College, Kaohsiung City, Taiwan
| | - Shengyun Liu
- Department of Rheumatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Quan Jiang
- Department of Rheumatology and Immunology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Liu
- Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinwei Chen
- Department of Rheumatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhizhong Ye
- Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| | - Min Chen
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingjuan Chen
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR, USA
| | - Ming Gao
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan He
- Department of Rheumatology and Immunology, the First Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Lin
- Department of Rheumatology, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Lijun Wu
- Department of Rheumatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Jianhua Xu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pinting Yang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of China Medical University, Beijing, China
| | - Xuewu Zhang
- Department of Rheumatology, Peking University People's Hospital, Beijing, China
| | - Qing Jiang
- Department of Osteoarthrosis, Affiliated Drum Tower Hospital, Nanjing University Medical College, Nanjing, China
| | - Guanghua Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wanling Yang
- Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| | - Xin Gu
- Beijing Hospital Rehabilitation Medicine, Beijing, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Dongyi He
- Department of Rheumatology and Immunology, Shanghai Guanghua Hospital, Shanghai, China
| | - Wei Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | | | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Hospital, Chinese Academy of Medical Sciences, Beijing, China
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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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Kawabata A, Hirai T, Tohara R, Yuasa M, Inose H, Koyanagi H, Sato S, Utagawa K, Hashimoto J, Okawa A, Yoshii T. Surgical stabilization of spinal metastasis in diffuse idiopathic skeletal hyperostosis ("Mets-on-DISH"): Two case reports. Medicine (Baltimore) 2020; 99:e20397. [PMID: 32481429 DOI: 10.1097/md.0000000000020397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Tohara
- Department of Orthopedic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura City, Ibaraki, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Koyanagi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shingo Sato
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kurando Utagawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Okada E, Shiono Y, Nishida M, Mima Y, Funao H, Shimizu K, Kato M, Fukuda K, Fujita N, Yagi M, Nagoshi N, Tsuji O, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation. J Orthop Surg (Hong Kong) 2020; 27:2309499019843407. [PMID: 31079563 DOI: 10.1177/2309499019843407] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To validate the effectiveness of percutaneous pedicle screw (PPS) fixation for spinal fractures associated with diffuse idiopathic skeletal hyperostosis (DISH) by comparing surgical outcomes for PPS fixation and conventional open posterior fixation. Patients with DISH are vulnerable to unstable spinal fractures caused by trivial trauma, and these fractures have high rates of delayed paralysis, postoperative complications, and mortality. METHODS This retrospective study assessed surgical outcomes for 16 patients with DISH (12 men; mean age 76.1 ± 9.4 years) who underwent PPS fixation for spinal fractures (pedicle screw (PS) group), and for a control group of 25 patients with DISH (18 men; mean age 77.9 ± 9.9 years) who underwent conventional open fixation (O group) at our affiliated hospitals from 2007 to 2017. We evaluated the preoperative physical condition (American Society of Anesthesiologists (ASA) classification), neurological status (Frankel grade), and improvement after surgery, fusion length, operating time, estimated blood loss, and perioperative complications. RESULTS Preoperatively, the PS group consisted of one ASA-1 patient, eight ASA-2 patients, six ASA-3 patients, and one ASA-4 patient; by Frankel grade, there were 2 grade B patients, 13 grade C, 4 grade D, and 6 grade E patients. The O group had 2 ASA-1 patients, 13 ASA-2, 9 ASA-3, and 1 ASA-4 patients. Frankel grades in the O group reflected severe neurological deficits, with 3 grade C patients, 2 grade D, and 11 grade E ( p = 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p = 0.410) and mean fusion length (PS 5.1 ± 0.8 segments; O 4.9 ± 1.2). The mean operating time and estimated blood loss were 168.1 ± 46.7 min and 133.9 ± 116.5 g, respectively, in the PS group, and 224.6 ± 49.8 min and 499.9 ± 368.5 g in the O group. Three O-group patients died of hypovolemic shock, respiratory failure, and pneumonia, respectively, within a year of surgery. CONCLUSION Conventional open posterior fixation and PPS fixation for DISH-related spinal fractures were similar in fusion length and neurological improvement. However, PPS fixation was less invasive and had lower complication rates.
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Affiliation(s)
- Eijiro Okada
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Yuta Shiono
- 2 Keio Spine Research Group, Tokyo, Japan.,3 Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Mitsuhiro Nishida
- 2 Keio Spine Research Group, Tokyo, Japan.,3 Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Yuichiro Mima
- 2 Keio Spine Research Group, Tokyo, Japan.,4 Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Haruki Funao
- 2 Keio Spine Research Group, Tokyo, Japan.,5 Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan
| | - Kentaro Shimizu
- 2 Keio Spine Research Group, Tokyo, Japan.,6 Department of Orthopaedic Surgery, Sano General Hospital, Tochigi, Japan
| | - Masanori Kato
- 2 Keio Spine Research Group, Tokyo, Japan.,7 Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kentaro Fukuda
- 2 Keio Spine Research Group, Tokyo, Japan.,8 Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Nobuyuki Fujita
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Mitsuru Yagi
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Narihito Nagoshi
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Osahiko Tsuji
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Ken Ishii
- 2 Keio Spine Research Group, Tokyo, Japan.,5 Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan
| | - Masaya Nakamura
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Morio Matsumoto
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Kota Watanabe
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to assess the incidence and trends of the spine fracture hospitalization and surgery in Finland in 1998-2017. SUMMARY OF BACKGROUND DATA Traumatic spine fractures are rare, yet they are known to cause significant long-term disability and therefore social, functional, and financial burden. The incidence of spine fractures and related mortality has been suggested to have declined during recent years. However, there are no population-based studies investigating the incidence of surgical treatment of spine fractures. METHODS The data for this study was obtained from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients 20 years of age or over in Finland during a 20-year period from January 1, 1998 to December 31, 2017. RESULTS A total of 54,612 patients were hospitalized for a spine fracture in Finland in 1998-2017, and 7138 (13%) of the patients underwent surgery. The annual population-based incidence of spine fracture hospitalization increased 57% during the 20-year period, from 57 per 100,000 person-years to 89 per 100,000 person-years. In addition, the incidence of spine fracture surgery increased 65%, from 5.3 per 100,000 person-years to 8.8 per 100,000 person-years. The incidence of cervical spine fracture surgery tripled, and thoracic spine surgery doubled from 1998 to 2017, while incidence of lumbar fracture surgery declined by 13%. Among patients 60 years of age or older, the incidence of cervical spine fracture surgery increased 400%. CONCLUSION Incidences of cervical, thoracic, and lumbar fracture hospitalizations increased constantly in Finland during 1998-2017. Accordingly, incidence of cervical and thoracic spine fracture surgery increased rapidly, whereas the incidence of lumbar fracture surgery even decreased, during this 20-year period. LEVEL OF EVIDENCE 3.
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Prevalence of Diffuse Idiopathic Skeletal Hyperostosis in the General Elderly Population: A Japanese Cohort Survey Randomly Sampled From a Basic Resident Registry. Clin Spine Surg 2020; 33:123-127. [PMID: 31851012 DOI: 10.1097/bsd.0000000000000919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY DESIGN This is a Japanese resident cohort study based on a municipal registry. OBJECTIVES In this study of an aged Japanese population, we used random sampling from the basic resident registry of a rural town for subject selection to investigate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and effect of subject-related factors. SUMMARY OF BACKGROUND DISH is a condition characterized by the calcification and ossification of soft tissues. Interest is mounting on DISH as the elderly rate increases, but its pathogenetic mechanism remains unknown. DATA A total of 413 aged people randomly sampled from the resident registry of Obuse town. MATERIALS AND METHODS We established 8 groups on the basis of age (50s, 60s, 70s, and 80s) and sex after random sampling from the resident registry of Obuse town. A total of 411 participants (202 male and 209 female) were enrolled and underwent a single whole-spine lateral radiographic examination. We assessed for the existence of DISH and analyzed the effects of clinical factors using multivariate analysis. RESULTS A total of 72 (17.5%) participants were identified to have DISH in our population cohort. The prevalence of DISH tended to increase with age, being 3.1% in subjects in their 50s, 14.0% in their 60s, 24.3% in their 70s, and 29.0% in their 80s. According to multivariate analysis, hypertension (HT), male, bone mineral density (BMD), and aging were independent factors associated with DISH. The odds ratios of HT, male, and BMD were 1.93, 2.88, and 19.1, respectively. CONCLUSIONS This is the first study examining DISH in detail according to age and sex groups on a general population basis. Multivariate analysis revealed HT, male, BMD, and aging to be independent factors associated with DISH in the healthy community-dwelling elderly.
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Salaffi F, Carotti M, Di Carlo M, Sessa F, Malavolta N, Polonara G, Giovagnoni A. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med 2020; 125:654-667. [DOI: 10.1007/s11547-020-01156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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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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A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis-A Nationwide Multicenter Study. J Clin Med 2020; 9:jcm9010208. [PMID: 31940926 PMCID: PMC7019396 DOI: 10.3390/jcm9010208] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/17/2022] Open
Abstract
In diffuse idiopathic hyperostosis (DISH), the ankylosed spine becomes susceptible to spinal fractures and spinal cord injuries due to the long lever arms of the fractured segments that make the fracture extremely unstable. The aim of this retrospective multicenter study was to examine the differences in DISH-affected spine fractures according to fracture level. The data of 285 cases with fractures of DISH-ankylosed segments diagnosed through computed tomography (CT) imaging were studied and the characteristics of 84 cases with cervical fractures were compared to 201 cases with thoracolumbar fractures. Examination of the CT images revealed that cervical fracture cases were associated with ossification of the posterior longitudinal ligament and had fractures at the intervertebral disc level, while thoracolumbar fracture cases were associated with ankylosing of the posterior elements and had fractures at the vertebral body. Neurologically, cervical fracture cases had a higher ratio of spinal cord injury leading to higher mortality, while thoracolumbar fracture cases had lower rates of initial spinal cord injury. However, a subset of thoracolumbar fracture cases suffered from a delay in diagnosis that led to higher rates of delayed neurological deterioration. Some of these thoracolumbar fracture cases had no apparent injury episode but experienced severe neurological deterioration. The information provided by this study will hopefully aid in the education of patients with DISH and raise the awareness of clinicians to potential pitfalls in the assessment of DISH trauma patients.
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Adel H, Khan SA, Adil SO, Huda F, Khanzada U, Manohar M, Masood K. CT-Based Evaluation of Diffuse Idiopathic Skeletal Hyperostosis in Adult Population; Prevalence, Associations and Interobserver Agreement. J Clin Densitom 2020; 23:44-52. [PMID: 30583921 DOI: 10.1016/j.jocd.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH), being an asymptomatic condition, is generally discovered incidentally on imaging and it has not received much attention for research on clinical grounds. We assessed the prevalence of DISH, its associated factors, and interobserver agreement for computed tomography (CT)-based diagnosis of DISH. CT scans of chest, abdomen, and pelvis performed for various clinical indications were retrospectively reviewed. Resnick criteria were used for the diagnosis of DISH. Moreover, enthesopathy along with comorbidities was assessed. CT scans were observed by 3 observers having different experience levels. Out of total 416 patients, the prevalence of DISH was 30.8%. Strong positive agreement was observed between observer 1 and 2 (k = 0.89), observer 1 and 3 (k = 0.91), and observer 2 and 3 (k = 0.94). Reporting rate of DISH was 59.3%. Regression analyses showed that enthesopathy was 2.45 times (adjusted odds ratio [AOR]: 2.45, 95% confidence intervals [CI]: 1.48-4.05), diabetic patients were 4.74 times (AOR: 4.74, 95% CI: 2.89-7.78) while hypertensive patients were 2.17 times (AOR: 2.17, 95% CI: 1.30-3.62) more likely to have DISH in comparison to those who do not have DISH. A high prevalence of DISH was observed in our cohort. Enthesopathy and comorbidities like diabetes and hypertension were significant factors associated with DISH. Moreover, excellent agreement was observed in defining DISH on CT according to Resnick criteria.
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Affiliation(s)
- Hatem Adel
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohail Ahmed Khan
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Omair Adil
- Department of Research, Dow University of Health Sciences, Karachi, Pakistan.
| | - Farheen Huda
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Usman Khanzada
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Murli Manohar
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Kamran Masood
- Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
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Abstract
The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes in the sacroiliac joints, and the so-called non-radiographic axSpA (nr-axSpA), in which by definition such changes are not present. This distinction is based on the ASAS classification criteria for axSpA, which are however not suitable for a diagnosis. According to the current classification, spondyloarthritis (SpA) includes axSpA, which can be associated with psoriasis and/or chronic inflammatory bowel diseases (CED), such as Crohn's disease and ulcerative colitis, and peripheral SpA, which is further divided into SpA associated with psoriasis, partially synonymous with psoriatic arthritis (PsA), reactive SpA, partially synonymous with reactive arthritis (ReA) and SpA associated with CED, partially synonymous with arthritis associated with CED (e.g. Crohn's disease, ulcerative colitis) and peripheral undifferentiated SpA, which by definition is not associated with any of the above. In this article only the most important differential diagnoses are discussed, i. e. diffuse idiopathic skeletal hyperostosis (DISH), fractures and infections in the axial skeleton. In addition, the frequency of certain musculoskeletal findings in the normal population examined by magnetic resonance imaging (MRI) are also discussed.
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Kato S, Terada N, Niwa O. Surgical Treatment of Osteoporotic Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis along with Comparative Assessment of the Levels of Affected Vertebra or Anterior Column Reconstruction. Spine Surg Relat Res 2019; 4:57-63. [PMID: 32039298 PMCID: PMC7002056 DOI: 10.22603/ssrr.2019-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Surgical treatment of osteoporotic vertebral fracture (OVF) often involves older patients with various comorbidities; thus, attending physicians must pay special attention to the invasiveness of surgical procedures and possible perioperative complications. In this retrospective observational study, we investigated the relationship between OVF and diffuse idiopathic skeletal hyperostosis (DISH) by examining the clinical characteristics and surgical outcomes. Methods Subjects comprised 26 patients (14 men, 12 women) who underwent surgical treatment for OVF complicated by DISH. Vertebral injuries affected the thoracolumbar transitional vertebrae in 18 patients and the middle and lower lumbar vertebrae in eight patients. The clinical characteristics, surgical results, radiological assessments, and outcomes were evaluated on the basis of the levels of affected vertebrae and whether anterior column reconstruction (ACR) was performed. Results Visual Analog Scale (VAS) measurements improved from an average of 69.7 mm before surgery to 21.3 mm after surgery. 14 patients had neurological deficits, who exhibited improvements by one or more steps on the Frankel scale after surgery. Activities of daily living (ADLs) were maintained during the six-month period following surgery in 23 patients. Comorbidity was observed in 22 patients. 14 patients had perioperative complications, and six required additional surgery. Both operating time and blood loss volume were significantly higher in patients in the middle and lower lumbar vertebrae and ACR groups. Postoperative correction loss was also significantly lower in the ACR group. Conclusions Favorable degrees of improvement in neurological deficits and VAS were observed following surgery in patients with OVF complicated by DISH, and postoperative ADLs were maintained in 92% of the patients. Elderly men frequently presented with comorbidities, and the frequencies of patients with perioperative complications and those requiring additional surgery were high.
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Affiliation(s)
- Shinichi Kato
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Nobuki Terada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Osamu Niwa
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
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Clavaguera T, Reyner P, Valls R, de Cendra E, Rodríguez-Jimeno MC. Diffuse idiopathic skeletal hyperostosis: Can we identify a peripheral pattern? REUMATOLOGIA CLINICA 2019; 15:301-304. [PMID: 28528871 DOI: 10.1016/j.reuma.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
Diffuse idiopathic skeletal hyperostosis is a bone disease characterized by ossification of spinal ligaments and peripheral entheses. Currently, we still use the classic classification criteria that do not include extraspinal manifestations. A number of authors agree on the need to revise them. We present 3 patients in which a diagnosis of diffuse idiopathic skeletal hyperostosis could not be established if we apply those criteria, but they have fully compatible clinical and radiological manifestations of hyperostotic disease.
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Affiliation(s)
- Teresa Clavaguera
- Unidad de Reumatología, Hospital Universitario Doctor Trueta/Santa Caterina, Gerona, España.
| | - Patrícia Reyner
- Unidad de Reumatología, Hospital Universitario Doctor Trueta/Santa Caterina, Gerona, España
| | - Ramón Valls
- Unidad de Reumatología, Hospital de Palamós, Palamós, Gerona, España
| | - Eulàlia de Cendra
- Unidad de Reumatología, Hospital Santa Caterina, Salt, Gerona, España
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Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To investigate the prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in vertebral fracture patients admitted to our hospital. SUMMARY OF BACKGROUND DATA Although vertebral fracture is generally treated conservatively with rest and use of a corset, surgery with rigid internal fixation is recommended for vertebral fractures in patients with DISH. Thus, treatment strategies for vertebral fracture differ according to the presence or absence of DISH. However, only a few studies have investigated the prevalence of DISH in vertebral fracture patients. METHODS A total of 159 patients (49 men and 110 women, with a mean age of 82.9 years) who were diagnosed with fresh vertebral fracture and required admission to HITO Hospital. The diagnosis of fresh vertebral fracture was made using x-ray imaging, computed tomography, and magnetic resonance imaging, and the presence or absence of DISH was assessed. In addition, age, sex, bone mineral density ( % young adult mean), blood test results, treatment, and length of hospital stay were compared between patients with and without DISH. RESULTS The proportion of patients with DISH among the patients with vertebral fracture was 33.9% (54 of 159 patients). The proportions in men and women were 38.8% and 31.8%, respectively, with no significant difference between sexes (P = 0.39). The patients in the DISH group were older than those in the non-DISH group (83.6 vs. 79.4 years, P = 0.009), and the DISH group had higher glycated hemoglobin A1c (P = 0.005), higher bone mineral density (P = 0.042), and longer length of hospital stay (P = 0.0001) compared with those in the non-DISH group. CONCLUSION The proportion of patients with DISH among the vertebral fracture patients was 33.9%. Given that patients with DISH may require different treatment approaches, careful observation is needed. LEVEL OF EVIDENCE 3.
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