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Driesen T, Weiser L, Jäckle K, Klockner FS, Reinhold M, Lehmann W, Roch PJ. [Transosseous lacerations in the ankylosed cervical spine]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00113-024-01506-1. [PMID: 39636394 DOI: 10.1007/s00113-024-01506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2024] [Indexed: 12/07/2024]
Abstract
Transosseous lacerations represent a particular type of discoligamentous injury of the cervical spine and occur in ankylosing diseases of the spine, with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) being the primary entities. The altered biomechanics of the spine due to the underlying disease pose special challenges in the diagnostics and treatment. Even low-energy trauma can cause severe injuries of the cervical spine, which are often difficult to accurately diagnose due to the difficult assessability of the conventional projection radiography used in the primary diagnostics. In addition to a correct diagnosis a differentiated treatment concept is crucial as treatment courses can be complicated by pre-existing comorbidities, which are present in the majority of cases. Due to a high rate of secondary neurological deficits without adequate stabilization, surgical stabilization is generally recommended. Unlike the treatment of "classical" discoligamentous injuries in the mobile cervical spine, long segment dorsal instrumented spondylodesis is the standard of care for these cases, whereby ventral stabilization is also of value, either as a stand-alone or possibly additive procedure. The intraoperative site, which deviates from that of a normal patient, can present an additional challenge.
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Affiliation(s)
- Tobias Driesen
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Lukas Weiser
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Katharina Jäckle
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Friederike Sophie Klockner
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Maximilian Reinhold
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Paul Jonathan Roch
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Ohshima K, Nakashima H, Segi N, Ito S, Ouchida J, Takegami Y, Ishizuka S, Hasegawa Y, Imagama S. The prevalence and characteristics of diffuse idiopathic skeletal hyperostosis in the community-living middle-aged and elderly population: The Yakumo study. J Orthop Sci 2024; 29:1346-1352. [PMID: 37872071 DOI: 10.1016/j.jos.2023.10.005] [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: 05/24/2023] [Revised: 08/04/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The incidence of diffuse idiopathic skeletal hyperostosis (DISH) is increasing with the aging of the population. Asymptomatic DISH can decrease the spinal range of motion (ROM) and cause fractures. However, the prevalence or physical function of patients with DISH before experiencing fractures and other serious conditions is unclear. This study aimed to investigate the prevalence of DISH in the community residents on the basis of age and sex and characterize their physical function, ROM, and bone fragility. METHODS The subjects were community volunteers who attended a health checkup in 2018 and 2019. Overall, 455 subjects (mean age, 64.2 ± 9.7 years; 177 men) were included for analysis. We performed whole-spine lateral radiography for detecting DISH according to the criteria reported by Resnick. We compared the age, sex, body mass index (BMI), results of muscle strength and walking tests, ROM measured by SpinalMouse®, and quantitative ultrasound (QUS) of calcaneus with and without DISH. RESULTS DISH was detected in 83 (18.2%) cases. The DISH group was older (69.8 y.o. vs. 63.0 y.o.; p < 0.05) and comprised more men (prevalence: men, 27.7%; women, 12.2%; p < 0.001). BMI was high in the DISH group (24.8 vs. 23.3 kg/m2, p < 0.05). SpinalMouse measurements showed the DISH group had a significantly decreased ROM in the lumbar spine (43.2°, 57.2°, p < 0.05). The DISH group had a significantly lower T-score on the QUS measurement in the calcaneus (-2.0, -1.5, p < 0.05). There were, however, no significant differences between groups in both muscle strength test and walking test. CONCLUSION Subjects with DISH had decreased ROM in the lumbar spine and bone mineral density in calcaneal QUS. However, physical functions such as muscle strength and walking ability were similar among subjects with and without DISH without subjective symptoms.
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Affiliation(s)
- Kazuma Ohshima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takaya-cho, Konan-shi, Aichi, 483-8704, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1 Asashigaoka, Kashiwara-shi, Osaka, 582-0026, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
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Schröder G, Mittlmeier T, Falk SSI, Götz A, Kruse J, Akl E, Kröger H, Andresen JR, Andresen R, Schober HC, Glass Ä. Biomechanical Analysis of Diffuse Idiopathic Skeletal Hyperostosis and Osteoporosis: Vertebral Fracture Risk Evaluation Using Finite Element Modeling with Clinical and Micro-CT Data in an Elderly Donor. Biomedicines 2024; 12:2496. [PMID: 39595062 PMCID: PMC11592239 DOI: 10.3390/biomedicines12112496] [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: 09/12/2024] [Revised: 10/21/2024] [Accepted: 10/28/2024] [Indexed: 11/28/2024] Open
Abstract
Introduction: Biomechanical analysis of spinal structures is crucial in the evaluation of injuries, the risk of fracture, and age-related changes. Osteoporotic vertebrae are very fragile and therefore constitute a serious risk, especially in the elderly. Methods: At present, clinically relevant decision making in fracture risk assessment is predicated upon finite element analysis (FEA), which utilizes high-resolution computed tomography (CT) scans from clinical practice alongside micro-CT scans from laboratory settings. Of particular interest is the utilization of cortical vertebral body thicknesses, as meticulously measured via micro-CT. The data from a body donation over 80 years old with diffuse idiopathic skeletal hyperostosis (DISH) and osteoporosis (OP) were utilized through FEA to evaluate stresses in cortical and trabecular bone and to predict the stiffness and deformability of the examined vertebral bodies. Results: The investigation revealed a higher density of cortical and cancellous bone in vertebrae affected by DISH. Cortical density was highest in the thoracic section (median 188 µm), while cancellous bone density was 222 HU in the cervical vertebrae. The load on cortical bone increased as we progressed towards the lumbar spine; however, it remained quite constant in cancellous bone. Despite a low bone density, we registered no fractures in vertebrae. Conclusions: The data showed that DISH increased the thickness of the cortical bone and the density of the cancellous bone. The combination of increased cortical and cancellous bone density might reduce the risk of fracture in patients with low bone density. These conclusions emphasize the significance of biomechanical properties in the assessment of fracture risk and have important implications for clinical practice, particularly in relation to the prevention of vertebral fractures in osteoporotic patients with DISH.
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Affiliation(s)
- Guido Schröder
- Department of Traumatology, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany; (T.M.); (S.S.I.F.)
| | - Thomas Mittlmeier
- Department of Traumatology, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany; (T.M.); (S.S.I.F.)
| | - Steffi S. I. Falk
- Department of Traumatology, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany; (T.M.); (S.S.I.F.)
| | - Andreas Götz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Strasse 4, 18119 Rostock, Germany;
| | - Josephine Kruse
- Faculty of Medicine, University of Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany;
| | - Estelle Akl
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany;
| | - Hannes Kröger
- Silent Dynamics, Joachim-Jungius-Straße 9, 18059 Rostock, Germany;
| | - Julian Ramin Andresen
- Division of Trauma Surgery, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Reimer Andresen
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck und Hamburg, Esmarchstraße 50, 25746 Heide, Germany;
| | - Hans-Christof Schober
- OrthoCoast, Practice for Orthopedics and Osteology, Hufelandstraße 1, 17438 Wolgast, Germany;
| | - Änne Glass
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center, 18057 Rostock, Germany;
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Lai B, Gao Y, Meng Y, Gao R, Jiang H, Zhou X. Association between diabetes mellitus and ossification of the spinal ligament: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:691. [PMID: 39325228 DOI: 10.1007/s10143-024-02950-8] [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: 02/20/2024] [Revised: 08/23/2024] [Accepted: 09/22/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Ossification of the spinal ligament (OSL) is a spinal disorder characterized by abnormal bone formation in the spinal ligaments. Although clinical studies suggested that diabetes mellitus (DM) was associated with OSL, no consistent conclusion was drawn about the relationship between DM and the onset of OSL. METHODS Studies with data on DM and OSL were retrieved by searching PubMed, Embase, Web of Science, and Cochrane Library from inception to August 23, 2023. Pooled estimates of odds ratios (ORs) with 95% confidence interval (95% CI) were calculated using random-effects models. Statistical analyses were performed by R 4.2.2 software. RESULTS A total of 17 studies with 70,945 participants were included. The quantitative findings demonstrated that a higher risk of DM was related to the onset of OSL (OR = 2.19, 95% CI: 1.27-3.79, p = 0.008). Subgroup analysis showed a higher rate of DM in OSL patients from Japan (OR = 3.29, 95% CI: 1.51-7.17, [Formula: see text] = 0.009) than from other regions. Moreover, patients with OSL had a higher rate of DM in age < = 60 group (OR = 3.46, 95% CI: 1.14-10.50, p = 0.035) than age > 60 group (OR = 2.26, 95% CI: 1.07-4.79, p = 0.036). CONCLUSION DM is significantly associated with an increased risk of developing OSL, especially in Japanese and people under 60 years old. Further studies with more participants were warranted to confirm the findings and provide new insights into the prevention and treatment of OSL.
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Affiliation(s)
- Bowen Lai
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Yuan Gao
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Yichen Meng
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Heng Jiang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
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Herrán de la Gala D, Barba Arce AB, Lamagrande Obregón A, Landeras Álvaro RM, Cobo Ruiz T, Gallardo Agromayor EC. Diffuse idiopathic skeletal hyperostosis: Imaging findings with special focus on extraspinal involvement. RADIOLOGIA 2024; 66:447-458. [PMID: 39426813 DOI: 10.1016/j.rxeng.2023.06.009] [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: 04/24/2023] [Accepted: 06/01/2023] [Indexed: 10/21/2024]
Abstract
Diffuse Idiopathic Skeletal Hyperostosis (IDHS) is a multifactorial disease with a high prevalence and that is frequently detected incidentally in imaging tests. Most of its diagnostic criteria are focused on axial involvement and more specifically the spine. However, peripheral involvement in DISH is less well known despite its non insignificant frequency. DISH can be associated with serious complications, the most severe being vertebral fractures in low energy trauma and dysphagia or airway obstruction in cervical involvement. Knowing how to identify the patterns of peripheral involvement of DISH and its complications helps in the radiological and clinical management of patients with this disease.
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Affiliation(s)
- D Herrán de la Gala
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - A B Barba Arce
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - A Lamagrande Obregón
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - R M Landeras Álvaro
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - T Cobo Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - E C Gallardo Agromayor
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Brooks JK, Parsa A, Craig JS, Bell S, Song J, Varlotta SL, Price JB. Diffuse idiopathic skeletal hyperostosis (DISH): Detection on dental radiologic examinations in two older adults and overview of the literature. SPECIAL CARE IN DENTISTRY 2024; 44:1326-1332. [PMID: 38693642 DOI: 10.1111/scd.13005] [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: 01/29/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is a potentially serious osteopathic disorder associated with coalescing ossifications of the anterior vertebrae and may be concomitant with a constellation of symptomatology and systemic comorbidities. There is limited dental literature describing this finding on panoramic radiographs and cone beam computed tomography (CBCT) scans. CASE PRESENTATIONS Two case reports of DISH are provided. One patient manifested extensive ossifications along the cervical vertebrae and consequent episodes of dysphagia and hoarseness. The other affected patient's cervical ossification was found at an earlier stage of formation and without symptomatology. Panoramic radiography, cervical spine radiography, and CBCT examinations have been provided. CONCLUSION Attending dental healthcare practitioners should carefully evaluate all areas of interest and surrounding fields of view when taking panoramic radiographs and CBCT scans for manifestations of DISH and other potential disorders of the cervical vertebrae. A suspected radiologic finding of DISH should prompt timely referral for comprehensive medical assessment to mitigate neurologic deficits and other comorbidities.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Azin Parsa
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Jessica S Craig
- VA Maryland Healthcare System, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shereese Bell
- Predoctoral candidate, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Julia Song
- Predoctoral candidate, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sharon L Varlotta
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
- Director of Oral and Maxillofacial Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
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Santa Maria C, O'Dell K. Dysphagia as a Manifestation of Endocrine and Metabolic Disorders. Otolaryngol Clin North Am 2024; 57:657-668. [PMID: 38575488 DOI: 10.1016/j.otc.2024.02.024] [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] [Indexed: 04/06/2024]
Abstract
Dysphagia is a common manifestation of endocrine and metabolic diseases. Swallowing is a complex neuromuscular process, with an interplay of sensory and motor function, that has voluntary and involuntary control. Disruptions in any of these processes can cause significant dysphagia. Endocrine disorders and metabolic derangements are systemic conditions that affect multiple organ systems. They contribute to the development of neuropathies, myopathies, and motility disorders that lead to swallowing difficulty. Malnutrition and critical illness can lead to deconditioning and atrophy which can cause dysphagia, which in turn can lead to further malnutrition and deconditioning.
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Affiliation(s)
- Chloe Santa Maria
- Caruso Department of Otolaryngology Head & Neck Surgery, USC Voice Center, University of Southern California, 1537 Norfolk Street, Suite 5800, Los Angeles, CA 90033, USA
| | - Karla O'Dell
- Caruso Department of Otolaryngology Head & Neck Surgery, USC Voice Center, University of Southern California, 1537 Norfolk Street, Suite 5800, Los Angeles, CA 90033, USA.
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Brikman S, Mader R, Bieber A. High Frequency of Diffuse Idiopathic Skeletal Hyperostosis in Patients With Obesity Hypoventilation Syndrome. J Rheumatol 2024; 51:733-734. [PMID: 38621799 DOI: 10.3899/jrheum.2024-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Reuven Mader
- Rheumatic Diseases Unit, Emek Medical Center, Afula
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Bennett SC. Pathological caudal skeleton of an ichthyodectiform fish from the Upper Cretaceous Niobrara Formation of western Kansas, USA. PeerJ 2024; 12:e17353. [PMID: 38737736 PMCID: PMC11086299 DOI: 10.7717/peerj.17353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
A series of 12 contiguous caudal vertebrae of an ichthyodectiform fish from the Smoky Hill Chalk Member of the Niobrara Formation is described. The vertebral centra exhibit extensive overgrowth of pathological bone and there is additional pathological bone within the centra and intervertebral spaces, which together resulted in the coossification of most centra. The extent of the pathology is greatest on preural vertebrae 1-3 and decreases anteriorly, which suggests that the pathology began posteriorly and progressed anteriorly. In addition to the pathological overgrowth on bones, the specimen preserves features interpreted as calcified and/or ossified soft tissues associated with the neural and haemal canals. The pathologies are unlike previously described examples of bony pathologies in fish, and it is suggested that they resulted from combined bacterial and fungal infections. As the pathologies developed, they would have adversely impacted the fish's swimming and feeding abilities, and presumably eventually led to the fish's death.
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Affiliation(s)
- S Christopher Bennett
- Department of Biological Sciences, Fort Hays State University, Hays, KS, United States of America
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Schaefer RO, Rutsch N, Schnake KJ, Aly MM, Camino-Willhuber G, Holas M, Spiegl U, Muijs S, Albers CE, Bigdon SF. Rigid spine injuries - A comprehensive review on diagnostic and therapeutic challenges. BRAIN & SPINE 2024; 4:102811. [PMID: 38681176 PMCID: PMC11052905 DOI: 10.1016/j.bas.2024.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Injuries to the rigid spine have a distinguished position in the broad spectrum of spinal injuries due to altered biomechanical properties. The rigid spine is more prone to fractures. Two ossification bone disorders that are of particular interest are Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH). DISH is a non-inflammatory condition that leads to an anterolateral ossification of the spine. AS on the other hand is a chronic inflammatory disease that leads to cortical bone erosions and spinal ossifications. Both diseases gradually induce stiffening of the spine. The prevalence of DISH is age-related and is therefore higher in the older population. Although the prevalence of AS is not age-related the occurrence of spinal ossification is higher with increasing age. This association with age and the aging demographics in industrialized nations illustrate the need for medical professionals to be adequately informed and prepared. The aim of this narrating review is to give an overview on the diagnostic and therapeutic measures of the ankylosed spine. Because of highly unstable fracture configurations, injuries to the rigid spine are highly susceptible to neurological deficits. Diagnosing a fracture of the ankylosed spine on plain radiographs can be challenging. Moreover, since 8% of patients with ankylosing spine disorders (ASD) have multiple non-contagious fractures, a CT scan of the entire spine is highly recommended as the primary diagnostic tool. There are no consensus-based guidelines for the treatment of spinal fractures in ASD. The presence of neurological deficit or unstable fractures are absolute indications for surgical intervention. If conservative therapy is chosen, patients should be monitored closely to ensure that secondary neurologic deterioration does not occur. For the fractures that have to be treated surgically, stabilization of at least three segments above and below the fracture zone is recommended. These fractures mostly are treated via the posterior approach. Patients with AS or DISH share a significant risk for complications after a traumatic spine injury. The most frequent complications for patients with thoracolumbar burst fractures are respiratory failure, pseudoarthrosis, pneumonia, and implant failure.
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Affiliation(s)
| | - Niklas Rutsch
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mohamed M. Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Martin Holas
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Ulrich Spiegl
- Klinik für Unfallchirurgie und Orthopädie, Klinik München Harlaching, Sanatoriumspl. 2, 81545, München, Germany
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | - Christoph E. Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Sebastian F. Bigdon
- Department of Orthopaedic Surgery, Sonnenhof Spital, University Bern, 3006, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
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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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Appleby J. Ageing and disease risk factors: A new paleoepidemiological methodology for understanding disease in the past. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 44:33-45. [PMID: 38134630 DOI: 10.1016/j.ijpp.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To outline a methodology that enables the reconstruction of age-related disease risk in past societies. MATERIALS Modern epidemiological evidence considering risk factors for age-related disease is combined with contextual information about an archaeological society of interest. METHODS Data gathered is used to create a qualitative population-specific risk model for the disease of interest. To provide a case study, a risk model is constructed for Chronic Obstructive Pulmonary Disease (COPD) in the Eastern English Bronze Age. RESULTS This enables the first rigorous approach to reconstructing age-related disease risk in the past. A risk model shows a high degree of COPD risk in the Eastern English Bronze Age, with a major contribution from indoor airborne pollution and agricultural practices. SIGNIFICANCE This represents a significant new approach in human paleopathology, facilitating understanding of the occurrence of a wide variety of diseases in the past, without the need for well-preserved skeletons of identified elderly individuals. LIMITATIONS The risk models generated are, of necessity, qualitative rather than quantitative, since we are unable to calculate the size of risk factors in the past with certainty. SUGGESTIONS FOR FURTHER RESEARCH The methodology could be applied to a wide variety of diseases and for many past societies.
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Affiliation(s)
- Jo Appleby
- School of Archaeology and Ancient History, University of Leicester, University Road, Leicester LE1 7RH, England.
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13
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Yalçınkaya B, Çolak AF, Yıldız AE, Özçakar L. Ossified/sequestrated lumbar disc: A ricochet in diffuse idiopathic skeletal hyperostosis. Pain Pract 2024; 24:575-576. [PMID: 38038142 DOI: 10.1111/papr.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Berkay Yalçınkaya
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ahmet Furkan Çolak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Adalet Elçin Yıldız
- Department of Radiology, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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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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15
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Vierunen RM, Haapamäki VV, Koivikko MP, Bensch FV. Post-traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH). Eur Radiol 2023; 33:9425-9433. [PMID: 37382616 PMCID: PMC10667401 DOI: 10.1007/s00330-023-09866-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH). MATERIALS AND METHODS A retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports. RESULTS Of 70 post-traumatic patients (54 men, median age 73, IQR 66-81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI. CONCLUSIONS SEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression. CLINICAL RELEVANCE STATEMENT Low-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation. KEY POINTS • Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH. • Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma. • Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.
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Affiliation(s)
- Riku M Vierunen
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland.
| | - Ville V Haapamäki
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Mika P Koivikko
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Frank V Bensch
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
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Bekaryssova D, Mruthyunjaya Vijaya P, Ahmed S, Sondur S, Zimba O. Revisiting articular syndrome in the peri-pandemic COVID-19 era. Rheumatol Int 2023; 43:2157-2166. [PMID: 37747562 DOI: 10.1007/s00296-023-05459-3] [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: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Articular syndrome is often the presentation of a person's various rheumatic or related diseases. It includes both arthralgia and arthritis, with objective signs of joint inflammation defining the latter. This syndromic approach to joint pain enables a scientific method for early diagnosis of common rheumatic conditions without compromising the recognition of uncommon conditions. This review explores common rheumatic conditions associated with articular syndrome, including osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE). It supports the early differentiation of uncommon but emerging entities such as reactive arthritis (ReA). The aim of the review is to comprehensively overview various forms of articular syndrome to update rheumatologists' and allied health specialists' knowledge. Epidemiology, clinical presentations, diagnostic approaches, and therapeutic strategies are discussed in the context of articular syndrome. The challenges emerging in the peri-pandemic COVID-19 era are highlighted. The improved understanding of the spectrum of clinical conditions and disease states presenting with articular syndrome may facilitate early diagnosis, optimal management, and enhanced patient outcomes within the realm of rheumatology.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Prakashini Mruthyunjaya Vijaya
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Suhas Sondur
- Department of Orthopedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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17
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Ishimura D, Morino T, Murakami Y, Yamaoka S, Kinoshita T, Takao M. Examining the Association Between the Extent of Anterior Longitudinal Ligament Ossification Progression and Comorbidities in Diffuse Idiopathic Skeletal Hyperostosis. Cureus 2023; 15:e51357. [PMID: 38292970 PMCID: PMC10824704 DOI: 10.7759/cureus.51357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND It has been documented that diffuse idiopathic skeletal hyperostosis (DISH) exhibits a higher prevalence among elderly, male, and obese individuals. Additionally, diabetes mellitus and other comorbidities are more frequently observed in this patient population. However, there is a lack of reports exploring the correlation between the extent of ossification and these demographic and clinical characteristics. OBJECTIVE To examine the correlation between comorbidities and the severity of ossification of the anterior longitudinal ligament in patients with DISH. MATERIALS AND METHODS The study included 468 patients who visited our hospital in 2018-2022. They were divided into DISH and non-DISH groups based on computed tomography image evaluation according to the Resnick criteria. The patients in the two groups were matched for age and sex. We compared comorbidity-related factors including body mass index (BMI), serum markers for metabolic syndrome and renal function, and hemoglobin A1c (HbA1c) levels between the matched groups. Moreover, we examined the correlation between the number of fused vertebral bodies and comorbidity-related factors, age, and sex within the DISH group. RESULTS The DISH group included significantly more men and elderly patients than the non-DISH group. Furthermore, the average BMI and HbA1c levels were significantly higher in the matched-DISH group than in the matched-non-DISH group, whereas no differences were observed in other markers. In the DISH group, the number of fused vertebral bodies did not correlate with age, sex, BMI, or HbA1c levels. DISCUSSION BMI and HbA1c levels were significantly higher in patients with DISH than those without; however, the number of fused vertebral bodies and the possibility of having coexisting obesity or diabetes mellitus showed no correlation with the age or sex of the patient. Therefore, each patient should be carefully assessed for ossification severity regardless of age, sex, and the comorbidities they possess.
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Affiliation(s)
- Daiki Ishimura
- Bone and Joint Surgery, Ehime University, School of Medicine, Ehime, JPN
| | | | - Yusuke Murakami
- Bone and Joint Surgery, Ehime University, School of Medicine, Ehime, JPN
| | - Shintaro Yamaoka
- Bone and Joint Surgery, Ehime University, School of Medicine, Ehime, JPN
| | - Tomofumi Kinoshita
- Bone and Joint Surgery, Ehime University, School of Medicine, Ehime, JPN
| | - Masaki Takao
- Bone and Joint Surgery, Ehime University, School of Medicine, Ehime, JPN
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18
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Tokuda K, Lu SL, Zhang Z, Kato Y, Chen S, Noda K, Hirose K, Usami Y, Uzawa N, Murakami S, Toyosawa S, Fukuda M, Sun-Wada GH, Wada Y, Noda T. Rab32 and Rab38 maintain bone homeostasis by regulating intracellular traffic in osteoclasts. Cell Struct Funct 2023; 48:223-239. [PMID: 37793839 PMCID: PMC11496785 DOI: 10.1247/csf.23061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
Osteoclasts play a crucial role in bone homeostasis by forming resorption pits on bone surfaces, resulting in bone resorption. The osteoclast expression of Rab38 protein is highly induced during differentiation from macrophages. Here we generated mice with double knockout (DKO) of Rab38 and its paralogue, Rab32, to investigate the roles of these proteins in osteoclasts. Bone marrow-derived macrophages from Rab32/38 DKO mice differentiated normally into osteoclasts in vitro. However, DKO osteoclasts showed reduced bone resorption activity. These osteoclasts also demonstrated defective secretion of tartrate-resistant acid phosphatase and cathepsin K into culture medium. Furthermore, the plasma membrane localization of a3, an osteoclast-specific a subunit of V-ATPase, was abrogated in DKO mice, substantiating the reduced resorption activity. In vivo, Rab32- and Rab38-positive cells were attached to the bone surface. Eight-week-old DKO mice showed significantly thickened trabecular bones in micro-CT and histomorphometry analysis, as well as reduced serum levels of cross-linked C-telopeptide of type I collagen, indicating diminished bone resorption in vivo. In DKO male mice over 10 weeks of age, hyperostosis appeared at the talofibular syndesmosis, the distal junction of the tibia and fibula. Furthermore, middle-aged mice (10 to 12 months of age) exhibited kyphosis, which is not usually observed in wild-type male mice until around 24 months of age. These results indicate that Rab32 and Rab38 contribute to osteoclast function by supporting intracellular traffic, thereby maintaining normal bone homeostasis.Key words: Rab32, Rab38, osteoclast, lysosome-related organelle, secretory lysosome.
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Affiliation(s)
- Kanako Tokuda
- Graduate School of Frontier Biosciences, Osaka University, Osaka 565-0871, Japan
| | - Shiou-Ling Lu
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Zidi Zhang
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Yumiko Kato
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
- Department of Oral & Maxillofacial Oncology and Surgery, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Siyu Chen
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Kazuya Noda
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
- Department of Periodontology and Regenerative Dentistry, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Katsutoshi Hirose
- Department of Oral and Maxillofacial Pathology, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Yu Usami
- Department of Oral and Maxillofacial Pathology, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Narikazu Uzawa
- Department of Oral & Maxillofacial Oncology and Surgery, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Shinya Murakami
- Department of Periodontology and Regenerative Dentistry, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Satoru Toyosawa
- Department of Oral and Maxillofacial Pathology, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Mitsunori Fukuda
- Department of Integrative Life Sciences, Graduate School of Life Sciences, Tohoku University, Miyagi 980-8578, Japan
| | - Ge-Hong Sun-Wada
- Department of Biochemistry, Faculty of Pharmaceutical Sciences, Doshisha Women’s College, Kyoto 610-0395, Japan
| | - Yoh Wada
- Department of Biological Sciences, Institute of Scientific and Industrial Research, Osaka University, Osaka 565-0871, Japan
- Center for Infectious Disease Education and Research, Osaka University, Osaka 565-0871, Japan
| | - Takeshi Noda
- Graduate School of Frontier Biosciences, Osaka University, Osaka 565-0871, Japan
- Department of Oral Cellular Biology, Center for Frontier Oral Science, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
- Center for Infectious Disease Education and Research, Osaka University, Osaka 565-0871, Japan
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Al-Jafari M, Abu Tapanjeh S, Al-Azzawi H, Abu Eid S, Baidoun HJ, Abu-Jeyyab M, Sarhan MY, Jbara H, Akel A. Cervical Spine Osteophyte: A Case Report of an Unusual Presentation. Cureus 2023; 15:e44762. [PMID: 37809146 PMCID: PMC10556974 DOI: 10.7759/cureus.44762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes abnormal bone growth at the sites of ligament insertion, mainly in the spine. It is of unknown etiology and usually affects older males. It is often asymptomatic, but it can sometimes cause dysphagia if it affects the anterior cervical spine. We report the case of a 50-year-old male patient with DISH who presented with chronic dysphagia and was diagnosed with a large cervical osteophyte compressing the esophagus. The patient had a history of several comorbidities, including diabetes, hypertension, stroke, and gout. He underwent surgical removal of the osteophyte and recovered well. We discuss the clinical features, diagnosis, and treatment options for this rare complication of DISH.
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Affiliation(s)
| | | | | | - Sura Abu Eid
- College of Medicine, Mutah University, Al-Karak, JOR
| | | | | | - Mohammed Y Sarhan
- Department of Orthopedic Surgery, Hashemite University, Al-Zarqaa, JOR
| | - Hiba Jbara
- Department of Neurosurgery, Al-Basheer Hospital, Amman, JOR
| | - Alaa Akel
- Department of Orthopedic Surgery, Mutah University, Al-Karak, JOR
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Shimizu T, Suda K, Harmon SM, Komatsu M, Ota M, Ushirozako H, Minami A, Takahata M, Iwasaki N, Takahashi H, Yamazaki M. The Impact of Diffuse Idiopathic Skeletal Hyperostosis on Nutritional Status, Neurological Outcome, and Perioperative Complications in Patients with Cervical Spinal Cord Injury. J Clin Med 2023; 12:5714. [PMID: 37685779 PMCID: PMC10488386 DOI: 10.3390/jcm12175714] [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: 08/08/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
This retrospective study aimed to investigate the characteristics of patients with cervical spinal cord injuries (CSCI) with diffuse idiopathic skeletal hyperostosis (DISH). We included 153 consecutive patients with CSCI who underwent posterior decompression and fusion surgery. The patients were divided into two groups based on the presence of DISH. Patient characteristics, neurological status on admission, nutritional status, perioperative laboratory variables, complications, neurological outcomes at discharge, and medical costs were compared between the groups. The DISH group (n = 24) had significantly older patients (72.1 vs. 65.9, p = 0.036), more patients with low-impact trauma (62.5% vs. 34.1%, p = 0.009), and a lower preoperative prognostic nutritional index on admission (39.8 vs. 42.5, p = 0.014) than the non-DISH group (n =129). Patients with DISH had significantly higher rates of ventilator management (16.7% vs. 3.1%, p = 0.022) and pneumonia (29.2% vs. 8.5%, p = 0.010). There was no significant difference in medical costs and neurological outcomes on discharge. Patients with CSCI and DISH were older, had poor nutritional status, and were prone to postoperative respiratory complications, while no differences were found between the neurological outcomes of patients with CSCI with and without DISH.
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Affiliation(s)
- Tomoaki Shimizu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Masahiro Ota
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai 072-0015, Hokkaido, Japan (H.U.)
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-0815, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-0815, Hokkaido, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
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Chen YH, Tsai WH, Chen YC, Chen KH, Ma KSK. Aortic-vertebral interaction in inflammation. Int J Rheum Dis 2023; 26:1874-1876. [PMID: 37017399 DOI: 10.1111/1756-185x.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/20/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Yu-Han Chen
- Department of Internal Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Wen Han Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Cheng Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Dyrek N, Wikarek A, Niemiec M, Kocełak P. Selected musculoskeletal disorders in patients with thyroid dysfunction, diabetes, and obesity. Reumatologia 2023; 61:305-317. [PMID: 37745138 PMCID: PMC10515130 DOI: 10.5114/reum/170312] [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: 05/12/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023] Open
Abstract
Many medical conditions affect the skeletal system and constitute independent risk factors for fractures. The action of thyroid hormones is necessary to maintain adequate development, mineralization, and bone strength. Untreated hyperthyroidism can lead to a decrease in bone mineral density (BMD), osteoporosis, and pathological fractures. In hypothyroidism, the changes in the quality of bone structure lead to an increase in the frequency of fractures. Excessive body weight negatively impacts fracture risk, increases the risk of osteoarthritis and accelerates the development of rheumatoid arthritis and osteoporosis. Type 1 and type 2 diabetes are associated with an increased risk of bone fractures despite different etiopathogenesis due to the duration of the disease and the pro-inflammatory state, the incorporation of advanced glycation end products (AGEs) into the bone matrix, and microvascular disorders. This study summarizes the current literature on the influence of thyroid dysfunction, obesity, and diabetes on the skeletal system.
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Affiliation(s)
- Nicola Dyrek
- Students’ Scientific Society at the Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Science, The Medical University of Silesia, Katowice, Poland
| | - Agnieszka Wikarek
- Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Science, The Medical University of Silesia, Katowice, Poland
| | - Małgorzata Niemiec
- Students’ Scientific Society at the Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Science, The Medical University of Silesia, Katowice, Poland
| | - Piotr Kocełak
- Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Science, The Medical University of Silesia, Katowice, Poland
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23
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Furukawa M, Fujiyoshi K, Okubo T, Yanai Y, Matsubayashi K, Kato T, Kobayashi Y, Konomi T, Yato Y. Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures. Asian Spine J 2023; 17:676-684. [PMID: 37408292 PMCID: PMC10460660 DOI: 10.31616/asj.2022.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN This study adopted a cross-sectional study design. PURPOSE This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). OVERVIEW OF LITERATURE The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. METHODS We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2-8), and maxVB (9-18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. RESULTS Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2-8) group had less A4 and more B1 and B2 fractures. The maxVB (9-18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2-8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9-18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9-18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. CONCLUSIONS The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.
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Affiliation(s)
- Mitsuru Furukawa
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Toshiki Okubo
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshihide Yanai
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Takashi Kato
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Tsunehiko Konomi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
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24
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Segi N, Nakashima H, Machino M, Ito S, Yokogawa N, Sasagawa T, Funayama T, Eto F, Yamaji A, Watanabe K, Nori S, Takeda K, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Shirasawa E, Inoue G, Kakutani K, Kakiuchi Y, Iizuka Y, Takasawa E, Akeda K, Takegami N, Kiyasu K, Tominaga H, Tokumoto H, Funao H, Oshima Y, Yoshii T, Kaito T, Sakai D, Ohba T, Seki S, Otsuki B, Ishihara M, Miyazaki M, Okada S, Imagama S, Kato S. Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture. Global Spine J 2023:21925682231186757. [PMID: 37401179 DOI: 10.1177/21925682231186757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. METHODS The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score-matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. RESULTS Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. CONCLUSIONS The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Takeshi Sasagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
- Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, School of Medicine, Hamamatsu University, Shizuoka, Japan
- Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
- Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo, Japan
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hidenori Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Nagano, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Nagano, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Munehiro Sakata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Orthopaedics, Saiseikai Shiga Hospital, Shiga, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, School of Medicine, Nihon University, Tokyo, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, School of Medicine, Nihon University, Tokyo, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology, and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology, and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yuji Kakiuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroto Tokumoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
- Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, School of Medicine, Tokai University, Kanagawa, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
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Giammalva GR, Maugeri R, Cusimano LM, Sciortino AS, Bonosi L, Brunasso L, Costanzo R, Signorelli F, Tumbiolo S, Iacopino DG, Visocchi M. Diffuse idiopathic skeletal hyperostosis: A functional enemy of vertebral stability - Case series and surgical consideration of craniovertebral junction involvement. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:274-280. [PMID: 37860019 PMCID: PMC10583796 DOI: 10.4103/jcvjs.jcvjs_72_23] [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: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 10/21/2023] Open
Abstract
Context Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's syndrome may reduce vertebral mobility, thus affecting the stability of adjacent vertebral segments and promoting spinal stenosis, vertebral dislocation, and unstable fracture secondary to low-energy trauma. Aims This study aimed to contribute with a case series of three patients affected by DISH undergone surgery with occipitocervical fixation for craniovertebral junction (CVJ) instability since the poor literature about CVJ instability and surgery in patients affected by DISH. Settings and Design This was a multicentric case series. Subjects and Methods Literature about CVJ instability and surgery in patients affected by DISH is poor. Thus, we present a case series of three patients affected by DISH, who underwent surgery with occipitocervical fixation with different clinical and radiological patterns. Results CVJ represents one of the most mobile joints of the spine and is at greater risk for instability. Moreover, instability itself may act as primum movens for several degenerative conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament, and cervical deformities. On the contrary, DISH itself may worsen CVJ instability because of subaxial spine stiffness. In case of DISH, the rigid unit formed by several ossified vertebral bodies acts as a long lever arm, increasing the forces applied to the hypermobile CVJ and reducing the dynamic buffer capability of ossified spine. On the other hand, vertebral instability increases the odds of fractures. In such cases, CVJ posterior instrumentation and fusion is an effective and feasible surgical technique, aimed to restore vertebral stability and to halt the progression of spinal stenosis. Conclusions Due to the altered dynamics cervical spine along with the possible comorbidities, treatment indication and surgery for patients affected by DISH must be tailored case by case.
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Affiliation(s)
- Giuseppe R Giammalva
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Luigi M Cusimano
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Andrea S Sciortino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Lapo Bonosi
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Lara Brunasso
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Roberta Costanzo
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvana Tumbiolo
- Department of Neurosurgery, Villa Sofia Hospital, Palermo, Unit of Neurosurgery, Hospital "Villa Sofia", Palermo, Italy
| | - Domenico G Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Unit of Neurosurgery, University of Palermo, Palermo, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Sethi A, Ruby JG, Veras MA, Telis N, Melamud E. Genetics implicates overactive osteogenesis in the development of diffuse idiopathic skeletal hyperostosis. Nat Commun 2023; 14:2644. [PMID: 37156767 PMCID: PMC10167361 DOI: 10.1038/s41467-023-38279-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition where adjacent vertebrae become fused through formation of osteophytes. The genetic and epidemiological etiology of this condition is not well understood. Here, we implemented a machine learning algorithm to assess the prevalence and severity of the pathology in ~40,000 lateral DXA scans in the UK Biobank Imaging cohort. We find that DISH is highly prevalent, above the age of 45, ~20% of men and ~8% of women having multiple osteophytes. Surprisingly, we find strong phenotypic and genetic association of DISH with increased bone mineral density and content throughout the entire skeletal system. Genetic association analysis identified ten loci associated with DISH, including multiple genes involved in bone remodeling (RUNX2, IL11, GDF5, CCDC91, NOG, and ROR2). Overall, this study describes genetics of DISH and implicates the role of overactive osteogenesis as a key driver of the pathology.
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Affiliation(s)
- Anurag Sethi
- Calico Life Sciences, LLC, South San Francisco, CA, 94080, USA.
| | - J Graham Ruby
- Calico Life Sciences, LLC, South San Francisco, CA, 94080, USA
| | - Matthew A Veras
- Calico Life Sciences, LLC, South San Francisco, CA, 94080, USA
| | - Natalie Telis
- Calico Life Sciences, LLC, South San Francisco, CA, 94080, USA
| | - Eugene Melamud
- Calico Life Sciences, LLC, South San Francisco, CA, 94080, USA.
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27
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Schwarz C, Schwarz M, Schmidbauer V, Kainberger F, Milos RI, Langenberger H, Gessl I, Funk G, Gschwantler M. Diffuse idiopathic skeletal hyperostosis as a cause for dysphagia in a patient with ankylosing spondylitis. Wien Klin Wochenschr 2023:10.1007/s00508-023-02205-4. [PMID: 37145247 DOI: 10.1007/s00508-023-02205-4] [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: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ankylosing spinal alterations which are often asymptomatic but may typically cause back pain and spinal stiffness. Presence of DISH may complicate spinal trauma and lead to unstable fractures requiring surgical intervention. Treatment options include physical activity, symptomatic treatment, local heat application, and optimization of metabolic comorbidities. CASE A multimorbid older patient was admitted to the gastroenterological ward for the investigation of progressive dysphagia and weight loss. Gastroscopy revealed a dorsal impression of the esophagus at 25 cm from the incisor. Clinical work-up including computed tomography (CT) and magnetic resonance imaging (MRI) ruled out malignancy but showed ankylosing spondylophytes and non-recent fractures of vertebrae C5-C7, compatible with DISH of the cervicothoracic spine as a cause for the esophageal impression. Notably, imaging diagnostics showed ankylosing spine alterations extending to the lumbar spine and both sacroiliac joints, suggestive of ankylosing spondylitis (AS). Typical imaging characteristics, a history of psoriasis, and positive HLA*B27 status supported the diagnosis of underlying AS in this patient with dysphagia as an unusual primary symptom of DISH. Additionally, pulmonary alterations compatible with a usual interstitial pneumonia (UIP)-like pattern were seen on lung CT. CONCLUSION Overlaps among AS, DISH and pulmonary abnormalities including UIP have been described previously; however, they represent unexpected findings in this older patient. This case underlines the importance of interdisciplinary collaboration and consideration of DISH as a differential diagnosis in patients with atypical symptoms.
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Affiliation(s)
- Caroline Schwarz
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Schwarz
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Herbert Langenberger
- Institute for Diagnostic and Interventional Radiology, Klinik Ottakring, Vienna, Austria
| | - Irina Gessl
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg Funk
- Department for Internal Medicine II, Klinik Ottakring, Vienna, Austria
| | - Michael Gschwantler
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria.
- Sigmund Freud University, Vienna, Austria.
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28
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Shiue Y, Chang TS. Diffuse Idiopathic Skeletal Hyperostosis Presenting With Hoarseness-A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231158796. [PMID: 37024447 DOI: 10.1177/01455613231158796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Unilateral vocal cord paralysis-related voice change is a common presentation in the otorhinolaryngology clinic. The well-known etiology was recurrent laryngeal nerve injury due to surgery, traumatic event, or tumor compression, but there are still other etiologies that could interfere with the route of the recurrence laryngeal nerve and lead to unilateral paralysis of the vocal cord. In this report, we presented a rare case of unilateral vocal cord paralysis resulting in diffuse idiopathic skeletal hyperostosis.
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Affiliation(s)
- Yih Shiue
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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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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Eshed I. Imaging Characteristics of Diffuse Idiopathic Skeletal Hyperostosis: More Than Just Spinal Bony Bridges. Diagnostics (Basel) 2023; 13:diagnostics13030563. [PMID: 36766667 PMCID: PMC9914876 DOI: 10.3390/diagnostics13030563] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by new bone formation and enthesopathies of the axial and peripheral skeleton. The pathogenesis of DISH is not well understood, and it is currently considered a non-inflammatory condition with an underlying metabolic derangement. Currently, DISH diagnosis relies on the Resnick and Niwayama criteria, which encompass end-stage disease with an already ankylotic spine. Imaging characterization of the axial and peripheral skeleton in DISH subjects may potentially help identify earlier diagnostic criteria and provide further data for deciphering the general pathogenesis of DISH and new bone formation. In the current review, we aim to summarize and characterize axial and peripheral imaging findings of the skeleton related to DISH, along with their clinical and pathogenetic relevance.
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Affiliation(s)
- Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel-Aviv 5265601, Israel
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Liu WZ, Chang ZQ, Bao ZM. Young thoracic vertebra diffuse idiopathic skeletal hyperostosis with Scheuermann disease: A case report. World J Clin Cases 2023; 11:655-661. [PMID: 36793636 PMCID: PMC9923856 DOI: 10.12998/wjcc.v11.i3.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder characterised by the calcification and ossification of ligaments and entheses. It is a frequent occurrence in elderly males, but rarely encountered in younger individuals.
CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d. Upon clinical examination and imaging tests, the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis. Before the operation and medical treatment, the patient had hypoesthesia of the skin below the xiphoid process. Afterward, a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied. Subsequently, the patient was given corticosteroids, neurotrophic drugs, hyperbaric oxygen and electric stimulation. As a result of the treatment, the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs. During follow-up, the patient’s skin sensation has returned to normal.
CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult. This provides a valuable reference point for spine surgeons, as DISH is more commonly observed in middle-aged and elder adults.
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Affiliation(s)
- Wen-Zheng Liu
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zheng-Qi Chang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zhe-Ming Bao
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
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Sirén A, Mattila K, Hirvonen J. The natural course of bridging osteophyte formation on MRI—A pictorial illustration. Radiol Case Rep 2022; 18:218-221. [PMID: 36340242 PMCID: PMC9633554 DOI: 10.1016/j.radcr.2022.10.011] [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: 09/11/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Diffuse skeletal hyperostosis is a common spinal disorder, but its pathophysiology is mostly unclear. The disorder can lead to a variety of symptoms, but many patients remain relatively asymptomatic. We present a case demonstrating the development of bridging osteophytes on a series of magnetic resonance images. An elderly person's spine was scanned repeatedly due to non-specific back pain during the last 4 years and the consecutive images revealed the formation of a bony bridge in the lumbar spine. Extensive bone marrow edema was seen during the formation of the osteophyte, suggestive of an ongoing inflammatory process. This case underlines that the inflammatory reaction in diffuse skeletal hyperostosis can be intense and prolonged, and its role might be worth studying further.
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Affiliation(s)
- Aapo Sirén
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland,Corresponding author.
| | - Kimmo Mattila
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland,Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Kuntokatu 2, 33520, Tampere, Finland
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Coexistence of flavum ligament ossification with diffuse idiopathic skeletal hyperostosis in the cervical spine: Review of literature and technical note starting from a rare case. Neurochirurgie 2022; 68:637-647. [PMID: 36087693 DOI: 10.1016/j.neuchi.2022.08.002] [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: 05/01/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cervical flavum ligament ossification (C-OLF) is very rare source of myeloradiculopathy. Less than 100 cases have been reported in modern English literature up to 2020. Association between C-OLF and Diffuse Idiopathic Skeletal Hyperostosis (DISH) at cervical level has never been described. METHODS In this article we performed a systematic review about epidemiology, physiopathology, clinical and surgical management of C-OLF. Moreover, we research its possible association with other cervical spine ligament ossification and in particular with anterior longitudinal ligament ossification. We report a case of 73 years-old woman experiencing mild cervical myeloradiculopathy caused by C6-C7 C-OLF compression and coexistence of DISH at cervico-thoracic level. A brief technical note about intraoperative management of C-OLF has also been described. RESULT Our research found 81 previous reported case of C-OLF. The coexistence of Posterior longitudinal ligament ossification has been reported in 21.3% of C-OLF case. Conversely, we reported the first case describing the association between DISH and C-OLF. Posterior surgical decompression is the only useful treatment providing good long-term functional outcome. Instrumentation should be tailored according to pre-operative findings. CONCLUSIONS C-OLF is a rare source of myeloradiculopathy and it may coexists with DISH probably due to alteration in the cervical mechanical stress and tendency of bone formation in patients harboring coexistent ligament ossifications. According to our result, skip en-bloc microsurgical laminectomy is safe and less invasive method to avoid complication and to provide optimal cervical spinal cord and nerve decompression avoiding CSF-leak.
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Harlianto NI, Kuperus JS, Mohamed Hoesein FAA, de Jong PA, de Ru JA, Öner FC, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review. Spine J 2022; 22:1490-1503. [PMID: 35283294 DOI: 10.1016/j.spinee.2022.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND CONTEXT Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine. PURPOSE Our previous systematic review on the epidemiological and clinical knowledge of dysphagia and airway obstruction caused by cervical DISH was updated, with a focus on (surgical) treatment and outcomes. STUDY DESIGN A systematic review of the literature was performed. METHODS Publications in Medline and EMBASE from July 2010 to June 2021 were searched. Two investigators performed data extraction and study specific quality assessment. RESULTS A total of 138 articles (112 case reports and 26 case series) were included, describing 419 patients with dysphagia and/or airway obstruction. The mean age of the patient group was 67.3 years (range: 35-91 years), and 85.4% was male. An evident increase of published cases was observed within the last decade. Surgical treatment was chosen for 66% of patients with the anterolateral approach most commonly used. The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. Improvement of dysphagia was observed in 95.5% of operated patients. After a mean follow-up of 3.7 years (range: 0.4-9.0 years), dysphagia recurred in 12 surgically treated patients (4%), of which five patients had osteophyte regrowth. CONCLUSIONS The number of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical DISH.
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Affiliation(s)
- Netanja I Harlianto
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Jonneke S Kuperus
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | | | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jacob A de Ru
- Department of Otolaryngology, Ministry of Defense, Central Military Hospital, Utrecht, The Netherlands
| | - F Cumhur Öner
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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Boldsen JL, Milner GR, Ousley SD. Paleodemography: From archaeology and skeletal age estimation to life in the past. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 178 Suppl 74:115-150. [PMID: 36787786 DOI: 10.1002/ajpa.24462] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022]
Abstract
Much of paleodemography, an interdisciplinary field with strong ties to archaeology, among other disciplines, is oriented toward clarifying the life experiences of past people and why they changed over time. We focus on how human skeletons contribute to our understanding of preindustrial demographic regimes, including when changes took place that led to the world as we know it today. Problems with existing paleodemographic practices are highlighted, as are promising directions for future work. The latter requires both better age estimates and innovative methods to handle data appropriately. Age-at-death estimates for adult skeletons are a particular problem, especially for adults over 50 years that undoubtedly are mistakenly underrepresented in published studies of archaeological skeletons. Better age estimates for the entirety of the lifespan are essential to generate realistic distributions of age at death. There are currently encouraging signs that after about a half-century of intensive, and sometimes contentious, research, paleodemography is poised to contribute much to understandings of evolutionary processes, the structure of past populations, and human-disease interaction, among other topics.
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Affiliation(s)
- Jesper L Boldsen
- ADBOU, University of Southern Denmark, Campusvej 55, Odense M, Denmark
| | - George R Milner
- Department of Anthropology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Stephen D Ousley
- Department of Anthropology, University of Tennessee, Knoxville, Tennessee, USA
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Wang W, Huang Y, Zhang L, Yang H. Percutaneous kyphoplasty for the treatment of diffuse idiopathic skeletal hyperostosis with vertebral fractures: A case report and treatment review. Front Surg 2022; 9:922139. [PMID: 35910472 PMCID: PMC9334769 DOI: 10.3389/fsurg.2022.922139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic metabolic condition characterized by new bone formation mainly at the anterolateral spine. Surgery such as screw fixation is commonly used for DISH patients who also suffer from vertebral fractures. In this case report, we share a DISH case with lumbar vertebral fracture and osteoporosis who underwent percutaneous kyphoplasty plus braces and medication. Percutaneous kyphoplasty, considered as minimally invasive surgery, may be another treatment option with the advantages of less trauma and faster recovery. The clinical information and radiological findings are described and treatments for DISH with vertebral fractures are then briefly reviewed.
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Kato H, Ansh AJ, Lester ER, Kinoshita Y, Hidaka N, Hoshino Y, Koga M, Taniguchi Y, Uchida T, Yamaguchi H, Niida Y, Nakazato M, Nangaku M, Makita N, Takamura T, Saito T, Braddock DT, Ito N. Identification of ENPP1 Haploinsufficiency in Patients With Diffuse Idiopathic Skeletal Hyperostosis and Early-Onset Osteoporosis. J Bone Miner Res 2022; 37:1125-1135. [PMID: 35340077 PMCID: PMC9177665 DOI: 10.1002/jbmr.4550] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
Homozygous ENPP1 mutations are associated with autosomal recessive hypophosphatemic rickets type 2 (ARHR2), severe ossification of the spinal ligaments, and generalized arterial calcification of infancy type 1. There are a limited number of reports on phenotypes associated with heterozygous ENPP1 mutations. Here, we report a series of three probands and their families with heterozygous and compound heterozygous ENPP1 mutations. The first case (case 1) was a 47-year-old male, diagnosed with early-onset osteoporosis and low-normal serum phosphate levels, which invoked suspicion for hypophosphatemic rickets. The second and third cases were 77- and 54-year-old females who both presented with severe spinal ligament ossification and the presumptive diagnosis of diffuse idiopathic skeletal hyperostosis (DISH). Upon workup, fibroblast growth factor 23 (FGF23) was noted to be relatively high in case 2 and serum phosphorous was low-normal in case 3, and the diagnoses of X-linked hypophosphatemic rickets (XLH) and ARHR2 were considered. Genetic testing for genes related to congenital hypophosphatemic rickets was therefore performed, revealing heterozygous ENPP1 variants in cases 1 and 2 (case 1, c.536A>G, p.Asn179Ser; case 2, c.1352A>G, p.Tyr451Cys) and compound heterozygous ENPP1 variants in case 3 constituting the same variants present in cases 1 and 2 (c.536A>G, p.Asn179Ser and c.1352A>G, p.Tyr451Cys). Several in silico tools predicted the two variants to be pathogeneic, a finding confirmed by in vitro biochemical analysis demonstrating that the p.Asn179Ser and p.Tyr451Cys ENPP1 variants possessed a catalytic velocity of 45% and 30% compared with that of wild-type ENPP1, respectively. Both variants were therefore categorized as pathogenic loss-of-function mutations. Our findings suggest that ENPP1 mutational status should be evaluated in patients presenting with the diagnosis of idiopathic DISH, ossification of the posterior longitudinal ligament (OPLL), and early-onset osteoporosis. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Hajime Kato
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Anenya J. Ansh
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Ethan R. Lester
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Yuka Kinoshita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoko Hidaka
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshitomo Hoshino
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Minae Koga
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Taisuke Uchida
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideki Yamaguchi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yo Niida
- Division of Genomic Medicine, Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Noriko Makita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Taku Saito
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Nobuaki Ito
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis center, The University of Tokyo Hospital, Tokyo, Japan
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Taher AW, Page PS, Greeneway GP, Ammanuel S, Bunch KM, Meisner L, Hanna A, Josiah D. Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21689. [PMID: 36303482 PMCID: PMC9379645 DOI: 10.3171/case21689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH) are considered highly unstable injuries with high risk for neurological injury. Surgical intervention is the standard of care for these patients to avoid secondary spinal cord injuries. Despite this, certain cases may necessitate a nonoperative approach. Herein within, the authors describe three cases of cervical, thoracic, and lumbar fractures in the setting of DISH that were successfully treated via orthosis. OBSERVATIONS The authors present three cases of fractures in patients with DISH. A 74-year-old female diagnosed with an acute fracture of a flowing anterior osteophyte at C6–C7 treated with a cervical orthosis. A 78-year-old male with an anterior fracture of the ankylosed T7–T8 vertebrae managed with a Jewett hyperextension brace. Finally, a 57-year-old male with an L1–L2 disc space fracture treated with a thoraco-lumbo-sacral orthosis. All patients recovered successfully. LESSONS In certain cases, conservative treatment may be more appropriate for fractures in the setting of DISH as an alternative to the surgical standard of care. Most fractures in the setting of DISH are unstable, therefore it is necessary to manage these patients on a case-by-case basis.
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Affiliation(s)
- Ayman W. Taher
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin; and
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Simon Ammanuel
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Katherine M. Bunch
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Lars Meisner
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Amgad Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Darnell Josiah
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
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Imaging of the Aging Spine. Radiol Clin North Am 2022; 60:629-640. [DOI: 10.1016/j.rcl.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Diffuse Idiopathic Skeletal Hyperostosis. Orthop Nurs 2022; 41:237-239. [PMID: 35772064 DOI: 10.1097/nor.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pongmanee S, Rojdumrongrattana B, Kritworakarn N, Sarasombath P, Liawrungrueang W. An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS). Int J Surg Case Rep 2022; 93:106993. [PMID: 35367943 PMCID: PMC8976121 DOI: 10.1016/j.ijscr.2022.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is a systemic condition characterized by calcification and ossification of ligaments and entheses which often mainly affects the thoracic spine. Anterior osteophyte compression of the esophagus resulting in dysphagia and dyspepsia is extremely rare in symptomatic thoracic DISH. Case presentation A 72-year-old male presented with dyspepsia and dysphagia for 10 months. A large beak-like anterior osteophyte, detected by a radiographic study and by a Barium esophagogram test at the T9-T10 level of the thoracic spine, was established by gastrointestinal medicine specialists to be the cause of the symptoms. The large anterior osteophyte was removed using video-assisted thoracoscopic surgery (VATS). At the one-year follow-up, the patient's symptoms had significantly improved and there was no recurrence of the osteophyte or the dyspepsia and dysphagia. Clinical discussion Thoracic DISH rarely presents with dysphagia and dyspepsia due to the greater mobility of the esophagus in the area of the thoracic spine than in the area of the cervical spine. This is the first reported case of symptomatic thoracic DISH treated by anterior thoracic osteophytectomy with VATS. The treatment was effective with no post-operative complications. Conclusion Anterior thoracic osteophytectomy with VATS is an effective surgical treatment option for this condition. Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is an extremely rare form of symptomatic thoracic DISH. Secondary dysphagia and dyspepsia can be caused by a giant beak-like anterior osteophyte at the T9-T10 levels of the thoracic spine. Surgical management with video-assisted thoracoscopic surgery (VATS) provides results superior to non-surgical treatments.
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Kosmidou P, Karamatzanis I, Angelis S, Anagiotos A, Aspris A. Cervical Diffuse Idiopathic Skeletal Hyperostosis: Rare Cause of Emergency Tracheostomy. Cureus 2022; 14:e20925. [PMID: 35145815 PMCID: PMC8811827 DOI: 10.7759/cureus.20925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/27/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a rare and potentially life-threatening syndrome. We present the case of a patient complaining about severe dyspnoea and diagnosed with vocal cord paresis. An emergency tracheotomy was performed to restore his breathing. Diagnostic imaging revealed large mass-occupying cervical osteophytes compressing the larynx. The osteophytes were removed via an anterior cervical approach, and vital signs were normalized. However, postoperatively, a fistula was discovered between the upper part of the oesophagus and the trachea. As a result, a gastrostomy tube had to be placed indefinitely. Literature review confirms the rare frequency of emergency tracheostomy due to DISH syndrome. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed.
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Sul JH, Yang J, Kim TW. Intraoperative Traction May Induce Acute Onset Dysphagia With Diffuse Idiopathic Skeletal Hyperostosis After Anterior Cervical Discectomy. Korean J Neurotrauma 2022; 18:126-131. [PMID: 35557636 PMCID: PMC9064748 DOI: 10.13004/kjnt.2022.18.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jung Hoon Sul
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Joochul Yang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Diffuse Idiopathic Skeletal Hyperostosis of the Spine: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2021; 29:1044-1051. [PMID: 34559699 DOI: 10.5435/jaaos-d-20-01344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is an ankylosing condition affecting up to 32.5% of the general cohort. Although often asymptomatic, affected individuals may present with back pain, stiffness, dysphagia, functional decline, and neurologic deficits. Radiographically, DISH is characterized by flowing ossifications along the anterior spine spanning ≥4 vertebral bodies. Although the etiology of DISH remains unknown, diabetes mellitus and other metabolic derangements are strongly associated with DISH. Importantly, spinal ankylosis in DISH predisposes patients to unstable spine fractures from low-energy trauma, and careful consideration must be taken in managing these patients. This article reviews the epidemiology and pathophysiology of DISH, and its clinical findings, diagnostic criteria, and management.
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Increased risk of stroke in patients with diffuse idiopathic skeletal hyperostosis: a nationwide population-based cohort study. Sci Rep 2021; 11:21349. [PMID: 34725397 PMCID: PMC8560951 DOI: 10.1038/s41598-021-00798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is frequently an incidental finding during X-ray examination. Although it has been shown to be associated with several chronic diseases, the hazard of cerebrovascular disease has seldom been explored. Our study aimed at determining the risk of stroke conferred by DISH, which is a retrospective cohort study adopting the largest medical database in Taiwan. Patients with a diagnosis of DISH at least three times from 2005 to 2010 were identified as the study group, and those in the control group were selected by matching age and gender. Patients were followed up until the end of 2015 to trace the incidence of stroke. Cox regression analysis was performed to compute the hazard ratio of stroke. Among the included 5300 patients, 1060 had a diagnosis of DISH. Significantly higher prevalence rates of stroke, hypertension, diabetes, and hyperlipidemia were noted in these patients. Overall, DISH conferred a 1.68 times higher risk of developing stroke. The significantly higher hazard ratio could be identified in both genders whether hypertension existed or not. Even in those without comorbidities, DISH still conferred a significantly higher risk of cerebrovascular disease in the future, which should never be ignored when encountered during clinical practice.
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Teixeira M, Ricardo Pires J, Ferreira FC, Rabadão T, Aveiro M, Neves N, Neves C. An unusual case of osteoarthritis? Clin Case Rep 2021; 9:e04662. [PMID: 34457289 PMCID: PMC8380071 DOI: 10.1002/ccr3.4662] [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: 06/17/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022] Open
Abstract
Forestier disease is a condition characterized by calcification and ossification of ligaments and entheses particularly affecting axial skeleton. Diagnosis is difficult and mandates a high suspicion level, but unexpensive and accessible examinations like a simple radiography might provide useful diagnostic clues in these challenging clinical scenarios and improve clinical assistance.
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Affiliation(s)
- Mariana Teixeira
- Internal Medicine Department of Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Joana Ricardo Pires
- Internal Medicine Department of Centro Hospitalar do Baixo VougaAveiroPortugal
| | | | - Tiago Rabadão
- Internal Medicine Department of Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Marcelo Aveiro
- Internal Medicine Department of Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Nuno Neves
- Imaging Department of Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Clarinda Neves
- Internal Medicine Department of Centro Hospitalar do Baixo VougaAveiroPortugal
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Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia-Molecular and Clinical Aspects. Int J Mol Sci 2021; 22:ijms22084255. [PMID: 33923907 PMCID: PMC8074005 DOI: 10.3390/ijms22084255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of the ligaments of the cervical spine; in some cases, it may result in dysphagia. The condition is more common in men over 50 years of age with metabolic disorders, and it is often asymptomatic and not a major issue for patients. The etiology of DISH is poorly understood, and known genetic factors indicate multiple signal pathways and multigene inheritance. In this review, we discuss the epidemiological, clinical, and etiological aspects of DISH with a special focus on dysphagia.
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Premachandra A, Bouthors C, Stephan F. Vertebral fracture following prone positioning in acute respiratory distress syndrome. Can J Anaesth 2021; 68:1292-1293. [PMID: 33846911 DOI: 10.1007/s12630-021-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Antoine Premachandra
- Intensive Care Unit, Marie Lannelongue Hospital (Groupe hospitalier Paris Saint Joseph), Le Plessis-Robinson, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - François Stephan
- Intensive Care Unit, Marie Lannelongue Hospital (Groupe hospitalier Paris Saint Joseph), Le Plessis-Robinson, France.
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Abstract
Psoriatic arthritis (PsA) is associated with decreased quality of life. As delayed diagnosis may lead to progressive joint destruction and long-term disability, the key clinical features of PsA should be recognizable to a wide range of clinicians to facilitate early diagnosis. In addition to assessment and identification of skin and nail lesions, which occur in up to 85% of those with musculoskeletal manifestations, clinicians should be aware of both the peripheral and axial manifestations of musculoskeletal disease reviewed here. Peripheral joint diseases include polyarticular, oligoarticular, distal, and arthritis mutilans subtypes, and cognizance of these patterns of disease, as well as periarticular manifestations, including dactylitis and enthesitis, is useful for swift diagnosis of PsA. Axial psoriatic arthritis (axial PsA), also known as the spondylitis subtype, may be limited to the spine and sacroiliac joints, but may also affect peripheral structures. Meticulous history-taking and physical examination and familiarity with appropriate imaging studies are often necessary to distinguish axial-PsA from other differential diagnoses. Swift diagnosis and treatment are necessary to both control PsA disease and mitigate the risks of the many associate comorbidities that may accompany it.
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Preface. Best Pract Res Clin Rheumatol 2020; 34:101561. [DOI: 10.1016/j.berh.2020.101561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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