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Zhang P, Zheng H, Luo J, Xu J. Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:364. [PMID: 38898517 PMCID: PMC11188160 DOI: 10.1186/s13018-024-04729-5] [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: 11/02/2023] [Accepted: 04/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy. METHODS A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings. RESULTS Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups. CONCLUSION In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.
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Affiliation(s)
- Peng Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Hongyu Zheng
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Jun Luo
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350000, China
| | - Jie Xu
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350000, China.
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Cruz D, Vieira D, Azenha M. Navigating airway challenges in Forestier's disease: approaching a patient with stridor. BMJ Case Rep 2024; 17:e260337. [PMID: 38839398 DOI: 10.1136/bcr-2024-260337] [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] [Indexed: 06/07/2024] Open
Affiliation(s)
- Daniela Cruz
- Anaesthesiology, Unidade Local de Saúde de Coimbra EPE, Coimbra, Portugal
| | - Daniel Vieira
- Anaesthesiology, Unidade Local de Saúde de Coimbra EPE, Coimbra, Portugal
| | - Marta Azenha
- Anaesthesiology, Unidade Local de Saúde de Coimbra EPE, Coimbra, Portugal
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Nakagawa H, Hamaguchi S. Diffuse idiopathic skeletal hyperostosis causing neck pain with dyspnea, dysphonia, and dysphagia. Am J Med Sci 2024:S0002-9629(24)01265-5. [PMID: 38801947 DOI: 10.1016/j.amjms.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Hiroaki Nakagawa
- Department of General Internal Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan.
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
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Fadhil M, Wong ACL, Jaeger M, Novakovic D, Le Lacheur M, MacKay S. Anterior cervical osteophytes: a rare culprit of unilateral vocal cord palsy. ANZ J Surg 2024; 94:967-969. [PMID: 38486437 DOI: 10.1111/ans.18934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Matthew Fadhil
- Department of Otolaryngology Head and Neck Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Chun Lok Wong
- Department of Otolaryngology Head and Neck Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
- Department of Otorhinolaryngology, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Matthias Jaeger
- Department of Neurosurgery, Wollongong Hospital, Wollongong, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Daniel Novakovic
- Department of Otolaryngology, Head and Neck Surgery, The Canterbury Hospital, Campsie, New South Wales, Australia
- Dr Liang Voice Program, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | | | - Stuart MacKay
- Department of Otolaryngology Head and Neck Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia
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Fournier DE, Battie MC, Séguin CA. Spatiotemporal changes in imaging features associated with diffuse idiopathic skeletal hyperostosis (DISH). RMD Open 2024; 10:e004074. [PMID: 38677879 PMCID: PMC11057289 DOI: 10.1136/rmdopen-2024-004074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVES The purpose of our study was to characterise spatiotemporal features of disease progression in people with diffuse idiopathic skeletal hyperostosis (DISH), early-phase DISH, and those not meeting either criterion who had repeated CT scans of the thoracic spine. METHODS A retrospective study was designed in collaboration with the Rochester Epidemiology Project to evaluate completeness of ectopic bridging across the thoracic spine and corresponding disease status over an average of 2.7 years (range from 0.2 to 15.0 years) in a cohort of 83 female and 74 male individuals. RESULTS Over 15% of individuals displayed changes in imaging features over time that resulted in a revised diagnosis along the continuum of DISH. Early-phase DISH was marked by new involvement of previously unaffected motion segments, estimated to occur over 2.1 years. Advanced presentations of DISH were marked by increased prevalence of complete bridging (average two of three available motion segments), estimated to occur over 2.6-2.9 years. Localised nodules of ectopic mineralisation external to and within the intervertebral disc were regularly observed in early-phase DISH. CONCLUSIONS This is the first characterisation of spatiotemporal features across all phases of DISH, indicating that progression of DISH is characterised by distinct features at different phases along the disease continuum. Localised nodules of mineralisation in the spinal ligaments and within the intervertebral discs coincident with early phases of the disease may be a key factor in the pathogenesis of DISH.
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Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - Michele C Battie
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Cheryle A Séguin
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
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Fournier DE, Leung AE, Battié MC, Séguin CA. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and early-phase DISH across the lifespan of an American population. Rheumatology (Oxford) 2024; 63:1153-1161. [PMID: 37481711 PMCID: PMC10986808 DOI: 10.1093/rheumatology/kead362] [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: 05/04/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVES DISH is a common musculoskeletal disorder; however, the imaging features and disease continuum from early to advanced stages is poorly understood. The purpose of this study was to evaluate the prevalence of DISH and early-phase DISH in an American population and to assess the extent and pattern of ectopic mineralization across the thoracic spine. METHODS Data were retrieved in collaboration with the Rochester Epidemiology Project. We conducted a retrospective image evaluation of a sample of individuals over 19 years of age with CT of the thoracic spine from a Northern US catchment area. Stratified random sampling by age and sex was used to populate the study. We examined the prevalence and extent of ectopic mineralization along the thoracic spine using previously established criteria. RESULTS A total of 1536 unique images (766 female and 770 male individuals) including 16 710 motion segments were evaluated for imaging features of the continuum of DISH. Collectively, 40.5% of all motion segments evaluated displayed evidence of ectopic mineralization in the thoracic spine. The prevalence of early-phase DISH was 13.2% (10.4% of female and 15.8% of male individuals). The prevalence of established DISH was 14.2% (7.4% of female and 20.9% of male individuals). Remarkable heterogeneity was detected in individuals within each disease classification, based on the extent of the thoracic spine affected and degree of mineralization. CONCLUSIONS The continuum of imaging features associated with DISH is detected in more than one in four adults and both sexes in an American population.
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Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences,The University of Western Ontario, London, ON, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - Andrew E Leung
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Michele C Battié
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences,The University of Western Ontario, London, ON, Canada
| | - Cheryle A Séguin
- Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
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Lyrtzis C, Poutoglidis A, Stamati A, Lazaridis N, Paraskevas G. A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach. Cureus 2024; 16:e59011. [PMID: 38800226 PMCID: PMC11127740 DOI: 10.7759/cureus.59011] [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: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Dysphagia is a common symptom with various underlying etiologies, making its management challenging even for experienced physicians. The presence of osteophytes in the cervical spine may often impede swallowing, displace the larynx, and cause a sore throat. We describe a case of an 85-year-old male who presented with a two-year history of progressive dysphagia, exacerbated over the last two months, especially with solid foods and liquids, prompting an ENT evaluation. Despite prior investigations, including normal gastroscopy and empirical pain management, further assessment revealed bulging masses in the hypopharynx indicative of cervical osteophytes. Conservative management, including speech and swallow therapy, dietary modifications, and pharmacological interventions, resulted in significant symptom improvement without surgical intervention. This case demonstrates the effectiveness of conservative treatment measures in treating dysphagia caused by cervical osteophytes, emphasizing the significance of a multidisciplinary approach for optimal patient care.
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Affiliation(s)
- Christos Lyrtzis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Athina Stamati
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - George Paraskevas
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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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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Miida S, Arao Y, Takeda N, Goto S, Kojima Y, Kimura N, Hayashi K, Tsuchiya A, Terai S. A rare cause of esophageal stenosis: Compression due to a thoracic osteophyte. DEN OPEN 2024; 4:e260. [PMID: 37409322 PMCID: PMC10318124 DOI: 10.1002/deo2.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023]
Abstract
Several cases of esophageal stenosis caused by cervical vertebral osteophytes have been reported; however, few reports of esophageal stenosis caused by thoracic osteophytes are available. We describe the case of an 86-year-old man with esophageal stenosis caused by a thoracic osteophyte near the tracheal bifurcation. An endoscopic ultrasonography examination was scheduled to determine the cause of acute pancreatitis; however, lacerations observed at the bifurcation following endoscope removal during prior esophagogastroduodenoscopy led us to cancel the ultrasonography to avoid potential esophageal perforation. A review of the present case and six similar previous cases of thoracic osteophyte-associated esophageal stenosis (identified via a systematic search of the PubMed database) demonstrated the clinical importance of a thoracic osteophyte near physiological esophageal stenosis. Esophagogastroduodenoscopy and computed tomography should be performed to screen for vertebral osteophytes before endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, and transesophageal echocardiography to avoid iatrogenic accidents.
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Affiliation(s)
- Suguru Miida
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Yoshihisa Arao
- Department of Gastroenterology and HepatologyUonuma Institute of Community Medicine, Niigata University Medical and Dental HospitalNiigataJapan
| | - Nobutaka Takeda
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Shu Goto
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Yuichi Kojima
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Naruhiro Kimura
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Kazunao Hayashi
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Shuji Terai
- Division of Gastroenterology and HepatologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
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Harlianto NI, Ezzafzafi S, Foppen W, Kuperus JS, van der Horst-Bruinsma IE, de Jong PA, Verlaan JJ. The prevalence of vertebral fractures in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100312. [PMID: 38370336 PMCID: PMC10869944 DOI: 10.1016/j.xnsj.2024.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
Background Subjects with ankylosing spinal disorders, including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) are more prone to vertebral fractures and frequently present with neurological deficit compared to the patients without an ankylosed spine. Moreover, prevalent vertebral fractures are an important predictor for subsequent fracture risk. However, the pooled fracture prevalence for DISH is unknown and less recent for AS. We aimed to systematically investigate the prevalence and risk of vertebral fractures in DISH and AS populations. Methods Publications in Medline and EMBASE were searched from January 1980 until July 2023 for cohort studies reporting vertebral fractures in AS and DISH. Data on prevalence were pooled with random effects modeling after double arcsine transformation. Heterogeneity was assessed with I2 statistics and we performed subgroup analysis and meta-regression to explore sources of heterogeneity. Results We included 7 studies on DISH (n = 1,193, total fractures = 231) with a pooled vertebral fracture prevalence of 22.6% (95%CI: 13.4%-33.4%). For AS, 26 studies were included (n = 2,875, total fractures = 460) with a pooled vertebral fracture prevalence of 15.2% (95%CI: 11.6%-19.1%). In general, fracture prevalence for AS remained similar for several study-level and clinically relevant characteristics, including study design, diagnostic criteria, spine level, and patient characteristics in subgroup analysis. AS publications from 2010 to 2020 showed higher fracture prevalence compared to 1990 to 2010 (18.6% vs. 11.6%). Fractures in DISH were most common at the thoracolumbar junction, whereas for AS, the most common location was the mid-thoracic spine. Conclusions Vertebral fractures are prevalent in AS and DISH populations. Differences in fracture distribution along the spinal axis exist between the 2 disorders. Additional longitudinal studies are needed for incident fracture assessment in patients with ankylosing spinal disorders.
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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
| | - Solaiman Ezzafzafi
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Wouter Foppen
- 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
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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Avrumova F, Goldman SN, Altorfer F, Paschal GK, Lebl DR. Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer-assisted navigation surgery: A case report. Clin Case Rep 2024; 12:e8427. [PMID: 38197064 PMCID: PMC10774538 DOI: 10.1002/ccr3.8427] [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: 10/20/2023] [Revised: 11/24/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message Diffuse idiopathic skeletal hyperostosis (DISH) involves spine ligament ossification. Computer-assisted navigation (CAN) effectively aids complex surgeries, such as anterior cervical osteotomy, to alleviate progressive DISH-related dysphagia. Abstract We describe a 68-year-old man with sudden onset dysphagia to both solids and liquids. Radiographic Imaging revealed DISH lesions from C2 down to the thoracic spine. The patient was successfully treated with CAN anterior osteotomy and resection of DISH lesions from C3-C6 and had complete symptom relief within 2 weeks post-operatively.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Samuel N. Goldman
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Franziska Altorfer
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Gregory K. Paschal
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Darren R. Lebl
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
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12
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Harlianto NI, Harlianto ZN. Patient characteristics, surgical treatment, and outcomes in spinal gout: a systematic review of 315 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3697-3703. [PMID: 37707602 DOI: 10.1007/s00586-023-07942-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/03/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To systematically investigate all published literature on spinal gout regarding location demographics, patient characteristics, treatment, and outcomes. METHODS We performed a systematic literature search of Medline and EMBASE from inception until April 15, 2023. Two investigators performed data extraction and quality assessment of location demographics and patient characteristics and outcomes of all article types describing spinal gout. RESULTS A total of 214 articles (204 case reports and 10 case series) were included, encompassing 315 subjects with spinal gout (81% male, mean age 58.1 years; range: 16-92). Most cases (36%) were between the age of 60-69 years. We observed an increase in publications and cases from 1950 to the present. Most patients were from institutions in Asia (n = 119, 37.8%) and North America (n = 96, 30.5%). Reported symptoms frequently included back pain (75%), radiating pain to extremities (27.3%), and weakness in the extremities (26.3%). The lumbar spine was most often affected. Pharmacological treatment was described for 108 (34.2%) patients. Surgery was performed for 146 (46.3%) of patients, of which 4.8% had postoperative complications. Three patients (2%) required secondary surgery for recurrence. CONCLUSION Published cases of spinal gout have increased over the last decades. Patient characteristics of spinal gout were similar to findings in systemic gout. Trends identified in patient characteristics and treatment outcomes may help guide patient management and improve our understanding of spinal gout.
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Affiliation(s)
- Netanja I Harlianto
- Department of Orthopedic Surgery, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
- Department of Radiology, University Medical Center Utrecht & Utrecht University, Utrecht, The Netherlands.
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Soares D, Bernardes F, Silva M, Miradouro J, Lopes D. Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Phagia: A Case Report and Review of Literature of a Rare Disease Manifestation. Cureus 2023; 15:e47221. [PMID: 38021777 PMCID: PMC10653550 DOI: 10.7759/cureus.47221] [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: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a clinical entity characterized by ossification of the anterolateral ligaments of the spine. DISH is more commonly diagnosed in older males, with an estimated prevalence of 42% in patients older than 65 years. As the disease affects predominantly the thoracic spine, dysphagia is a rare presentation of this entity observed in only 0.6-1.0% of the cases. We present a clinical case of an 84-year-old male with complaints of progressive dysphagia and foreign body sensation within one year of evolution. Computed tomography imaging revealed an anterior C4-C5 osteophyte compressing the posterior hypopharyngeal wall. Flexible endoscopy revealed a deformed and stenotic hypopharynx. The patient underwent surgical treatment with anterior cervical osteophyte resection using the Smith-Robinson approach. The patient showed significant improvement in preoperative symptoms, and no recurrence was detected at six months of follow-up. We also aim to discuss the clinical and radiological characteristics of the disease, as well as the crucial steps for a correct diagnosis and treatment of this rare disease.
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Affiliation(s)
- Diogo Soares
- Orthopaedics and Traumatology, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | - Francisco Bernardes
- Orthopaedics and Traumatology, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | - Marta Silva
- Orthopaedics and Traumatology, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | - José Miradouro
- Orthopaedics and Traumatology, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | - Daniel Lopes
- Orthopaedics and Traumatology, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
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14
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Davoodi F, Bazgir N, Naseri R. Diffuse Idiopathic Skeletal Hyperostosis Causing Progressive Dysphagia: A Case Report and Review. Case Rep Radiol 2023; 2023:8853575. [PMID: 37790679 PMCID: PMC10545457 DOI: 10.1155/2023/8853575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 10/05/2023] Open
Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) is a rare noninflammatory disorder impacting spinal longitudinal ligament and enthesis. The majority of DISH cases are asymptomatic or have few manifestations. Manifestations include neck pain and stiffness, stridor, breathing disturbances, and dysphagia. Case Presentation. A mid-aged man with progressive dysphagia to solid food was admitted to Loghman Hakim Hospital. In cervical X-ray, a huge ossification in the anterior longitudinal ligament was evident. Eventually, he was diagnosed with DISH. Because of coronary artery disease, conservative treatment was considered for him. Conclusion DISH is a rare disorder usually asymptomatic. In this case report, we present a DISH case with progressive dysphagia to solid foods.
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Affiliation(s)
- Farzin Davoodi
- Department of Otorhinolaryngology, Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Bazgir
- Hearing Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Naseri
- Department of Radiology, Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Mesolella M, Buono S, D'Aniello R, Ascione A, Motta G, Allosso S. Diffuse Idiopathic Skeletal Hyperostosis (DISH): Role of Logopedic Rehabilitation in Dysphagia. J Pers Med 2023; 13:994. [PMID: 37373983 DOI: 10.3390/jpm13060994] [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: 05/16/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Forestier's disease is a systemic, degenerative metabolic condition, which is still insufficiently investigated and understood, characterized by the progressive ossification of the ligaments and entheses. This case describes a 63-year-old man admitted to our department after several years of failed attempts to obtain a definitive diagnosis presenting with a painless mass in the pre-auricular region, gradually worsening dysphonia, severe dysphagia relating to solids, stiffness, and mild pain at the back of the neck. After performing further diagnostic tests, in addition to a pleomorphic adenoma, the simultaneous presence of diffuse spondylarthrosis on the cervical spine was highlighted, with beak-like osteophytes at C2-C5 resulting in esophageal compression. Given the absence of upper digestive endoscopy abnormalities, we initiated an intense logopedic and postural rehabilitative treatment, which led to a significant improvement in the patient's dysphagia symptoms. In addition, we limited the use of medical therapy to solely indomethacin in order to control the osteophytic process.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Sarah Buono
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Roberto D'Aniello
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Annarita Ascione
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80131 Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
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16
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Reigota CP, Barra C, Vilão F, Santos L. Dysphagia as a presentation of DISH. BMJ Case Rep 2023; 16:e254504. [PMID: 36863758 PMCID: PMC9990664 DOI: 10.1136/bcr-2022-254504] [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] [Indexed: 03/04/2023] Open
Affiliation(s)
| | - Cátia Barra
- Internal Medicine, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Filipe Vilão
- Internal Medicine, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Lèlita Santos
- Internal Medicine, Hospital and University Centre of Coimbra, Coimbra, Portugal
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17
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Seo M, Park JW. Head rotation as an effective compensatory technique for dysphagia caused by unilateral cervical osteophytes. J Int Med Res 2022; 50:3000605221116757. [PMID: 36036241 PMCID: PMC9434682 DOI: 10.1177/03000605221116757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Dysphagia is common in patients with cervical osteophytes. We aimed to
determine whether head rotation as a compensatory technique is effective for
dysphagia caused by unilateral cervical osteophytes. Methods We retrospectively analyzed videofluoroscopic swallowing study (VFSS) data
obtained in one university hospital. Patients whose VFSS showed pharyngeal
stasis by mechanical obstruction due to cervical osteophytes were selected.
They were divided into a unilateral skewed osteophyte group and a diffuse
central osteophyte group as confirmed by laryngoscopy or computed
tomography. The effect of head rotation on swallowing was investigated.
Fisher’s exact test was used for statistical analysis. Results Among 2876 patients who underwent VFSSs, we identified 48 patients with
osteophyte-induced dysphagia. The osteophytes were centrally located in 36
patients and unilateral in the remaining 12. Ten of the patients with
unilateral osteophytes showed improvement when they swallowed with head
rotation toward the osteophyte side, but none of the patients with central
osteophytes showed effective swallowing. A statistically significant
relationship was found between swallowing with head rotation and skewed
cervical osteophytes. Conclusion Swallowing with head rotation was safe, easy, and effective for patients with
dysphagia caused by unilateral cervical osteophytes. We advise attempting
this method prior to considering surgical approaches.
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Affiliation(s)
- Minsu Seo
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
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18
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Harlianto NI, Westerink J, Hol ME, Wittenberg R, Foppen W, van der Veen PH, van Ginneken B, Verlaan JJ, de Jong PA, Mohamed Hoesein FAA, Asselbergs FW, Nathoe HM, de Borst GJ, Bots ML, Geerlings MI, Emmelot MH, de Jong PA, Leiner T, Lely AT, van der Kaaij NP, Kappelle LJ, Ruigrok YM, Verhaar MC, Visseren FLJ, Westerink J. Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications. Rheumatol Adv Pract 2022; 6:rkac060. [PMID: 35993014 PMCID: PMC9382268 DOI: 10.1093/rap/rkac060] [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: 04/19/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives. DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity. Methods. This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure. Results. A total of 442 patients (9.4%) had evidence of DISH and 1789 (38%) patients had TAC. The prevalence of DISH increased from 6.6% in the no TAC group to 10.8% in the mild, 14.3% in the moderate and 17.1% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95% CI 1.19, 2.36)]. Conclusions. Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications.
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Affiliation(s)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University , Utrecht
| | | | | | | | | | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center , Nijmegen, The Netherlands
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