1
|
Sterneder CM, Tüngler TL, Haralambiev L, Boettner CS, Boettner F. Pelvic Roll Back Can Trigger Functional Psoas Impingement in Total Hip Arthroplasty. Arthroplast Today 2024; 27:101375. [PMID: 38680848 PMCID: PMC11047294 DOI: 10.1016/j.artd.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 05/01/2024] Open
Abstract
In most cases, impingement of the iliopsoas tendon after total hip arthroplasty is caused by acetabular component retroversion. The present case report describes a patient with functional iliopsoas impingement following total hip arthroplasty. With increasing flexibility of the hip joint after surgery, the functional adjustment to the stiff thoracolumbar spine in this patient with diffuse idiopathic skeletal hyperostosis resulted in progressive pelvic roll back. This roll back resulted in a functional iliopsoas impingement as the psoas tendon travels over the front of the pecten ossis pubis. Since excessive roll back is usually also addressed in primary total hip arthroplasty by decreasing anteversion of the acetabular component, surgeons should be aware to avoid the combination of roll back and decreased anteversion and their potential impact on iliopsoas impingement.
Collapse
Affiliation(s)
| | - Tim Ludwig Tüngler
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
2
|
Gazel U, Ayan G, Hryciw N, Delorme JP, Hepworth E, Sampaio M, Jibri Z, Karsh J, Aydin SZ. Disease-specific definitions of new bone formation on spine radiographs: a systematic literature review. Rheumatol Adv Pract 2024; 8:rkae061. [PMID: 38827363 PMCID: PMC11142627 DOI: 10.1093/rap/rkae061] [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: 09/07/2023] [Accepted: 03/24/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives We aimed to explore the radiographic definitions of types of New Bone formation (NBF) by focusing on the terminology, description and location of the findings. Methods Three systematic literature reviews were conducted in parallel to identify the radiographic spinal NBF definitions for spondyloarthritis (SpA), Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Osteorathritis (OA). Study characteristics and definitions were extracted independently by two reviewers. Definitions were analysed and collated based on whether they were unique, modified or established from previous research. Results We identified 33 studies that indicated a definition for the NBF in SpA, 10 for DISH and 7 for spinal OA. In SpA, the variations in syndesmophytes included the description as well as the subtypes and locations. The differentiation of syndesmophytes from osteophytes were included in 12 articles, based on the origin and the angle of the NBF and associated findings. The definitions of DISH varied in the number of vertebrae, level and laterality. For OA, five articles indicated that osteophytes arose from the anterior or lateral aspects of the vertebral bodies, and two studies required a size cut-off. Discussion Our ultimate aim is to create formal NBF definitions for SpA, DISH and OA guided by an atlas, through a Delphi exercise with international experts. The improved ability to differentiate these conditions radiographically will not only allow the clinicians to accurately approach patients but also will help the researchers to better classify patient phenotypes and focus on accurate radiographic outcomes.
Collapse
Affiliation(s)
- Ummugulsum Gazel
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gizem Ayan
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nicole Hryciw
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Philippe Delorme
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elliot Hepworth
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marcos Sampaio
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Zaid Jibri
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacob Karsh
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sibel Zehra Aydin
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
3
|
Ahmed O, Ramachandran K, Patel Y, Dhanapaul S, Meena J, Shetty AP, Bhari Thippeswamy P, Kanna RM, Rajasekaran S. Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans. Global Spine J 2024; 14:1201-1209. [PMID: 36289007 DOI: 10.1177/21925682221136844] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A Retrospective Study. OBJECTIVE To determine the prevalence and characteristics of DISH using whole spine CT scans and to evaluate the association of DISH with co-morbidities and other ossified lesions. METHOD A retrospective study of whole-spine CT scans of polytrauma patients from 2018-2021 above the age of 20 years. The screening was done using modified Resnick criteria. Overall and age-specific prevalence, characteristics, and associations with obesity, diabetes mellitus (DM), ischemic heart disease (IHD), aortic calcification (AC), ossified posterior longitudinal ligament (OPLL), and ossified ligamentum flavum (OLF) were evaluated. RESULTS Out of 1815 patients, 347 had DISH, with a prevalence rate of 19.1% and a mean age of 61.7 years. The highest prevalence of DISH was seen in individuals over 80 years of age (45.5%). The prevalence among males (20.2%) was higher than for females (14.9%). The most commonly involved level was T8-T9 (95.4%), followed by T9-T10 (91.9%), and the most common vertebra involved was T9 (96%). All the cases involving T9 had ossification on the right anterior aspect of the vertebral body. The presence of DM, high BMI, and IHD was found to be significantly higher in patients with DISH (P value < .001). The incidence of aortic calcification was 22.5%, OPLL was 13.3%, and OLF was 4.9% in patients with DISH. CONCLUSION This study reports a prevalence rate of 19.1% for DISH, with the highest prevalence among individuals above 80 years of age (45.5%). DISH has a higher propensity to affect the right anterior aspect of the vertebral body in the thoracic spine and is strongly associated with obesity, DM, IHD, and AC.
Collapse
Affiliation(s)
- Owais Ahmed
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Yogin Patel
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Sindhiya Dhanapaul
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Jalaj Meena
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | |
Collapse
|
4
|
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. [PMID: 38693642 DOI: 10.1111/scd.13005] [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: 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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Swart A, Hamouda A, Pennington Z, Lakomkin N, Mikula AL, Martini ML, Shafi M, Subramaniam T, Sebastian AS, Freedman BA, Nassr AN, Fogelson JL, Elder BD. Significant Reduction in Bone Density as Measured by Hounsfield Units in Patients with Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2024; 13:1430. [PMID: 38592686 PMCID: PMC10932308 DOI: 10.3390/jcm13051430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Multisegmental pathologic autofusion occurs in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). It may lead to reduced vertebral bone density due to stress shielding. Methods: This study aimed to determine the effects of autofusion on bone density by measuring Hounsfield units (HU) in the mobile and immobile spinal segments of patients with AS and DISH treated at a tertiary care center. The mean HU was calculated for five distinct regions-cranial adjacent mobile segment, cranial fused segment, mid-construct fused segment, caudal fused segment, and caudal adjacent mobile segment. Means for each region were compared using paired-sample t-tests. Multivariable regression was used to determine independent predictors of mid-fused segment HUs. Results: One hundred patients were included (mean age 76 ± 11 years, 74% male). The mean HU for the mid-construct fused segment (100, 95% CI [86, 113]) was significantly lower than both cranial and caudal fused segments (174 and 108, respectively; both p < 0.001), and cranial and caudal adjacent mobile segments (195 and 115, respectively; both p < 0.001). Multivariable regression showed the mid-construct HUs were predicted by history of smoking (-30 HU, p = 0.009). Conclusions: HUs were significantly reduced in the middle of long-segment autofusion, which was consistent with stress shielding. Such shielding may contribute to the diminution of vertebral bone integrity in AS/DISH patients and potentially increased fracture risk.
Collapse
Affiliation(s)
- Alexander Swart
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Abdelrahman Hamouda
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Anthony L. Mikula
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Michael L. Martini
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | | | - Arjun S. Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Brett A. Freedman
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jeremy L. Fogelson
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Benjamin D. Elder
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| |
Collapse
|
10
|
Ferreira CR, Carpenter TO, Braddock DT. ENPP1 in Blood and Bone: Skeletal and Soft Tissue Diseases Induced by ENPP1 Deficiency. ANNUAL REVIEW OF PATHOLOGY 2024; 19:507-540. [PMID: 37871131 PMCID: PMC11062289 DOI: 10.1146/annurev-pathmechdis-051222-121126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The enzyme ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) codes for a type 2 transmembrane glycoprotein that hydrolyzes extracellular ATP to generate pyrophosphate (PPi) and adenosine monophosphate, thereby contributing to downstream purinergic signaling pathways. The clinical phenotypes induced by ENPP1 deficiency are seemingly contradictory and include early-onset osteoporosis in middle-aged adults and life-threatening vascular calcifications in the large arteries of infants with generalized arterial calcification of infancy. The progressive overmineralization of soft tissue and concurrent undermineralization of skeleton also occur in the general medical population, where it is referred to as paradoxical mineralization to highlight the confusing pathophysiology. This review summarizes the clinical presentation and pathophysiology of paradoxical mineralization unveiled by ENPP1 deficiency and the bench-to-bedside development of a novel ENPP1 biologics designed to treat mineralization disorders in the rare disease and general medical population.
Collapse
Affiliation(s)
- Carlos R Ferreira
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas O Carpenter
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Demetrios T Braddock
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA;
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Suzuki T, Hino H, Magara J, Tsujimura T, Ito K, Inoue M. Effects of Head and Neck Alignment and Pharyngeal Anatomy on Epiglottic Inversion During Swallowing in Dysphagic Patients. Dysphagia 2023; 38:1519-1527. [PMID: 37149542 DOI: 10.1007/s00455-023-10579-w] [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: 12/08/2022] [Accepted: 04/07/2023] [Indexed: 05/08/2023]
Abstract
The effects of head and neck alignment and pharyngeal anatomy on epiglottic inversion remain unclear. This study investigated the factors involved in epiglottic inversion, including head and neck alignment and pharyngeal anatomy, in patients with dysphagia. Patients with a chief complaint of dysphagia and who underwent videofluoroscopic swallowing study at our hospital from January to July 2022 were enrolled. They were divided into three groups based on the degree of epiglottic inversion as the complete-inversion (CI), partial-inversion (PI), and non-inversion group (NI) groups. Data were compared among the three groups; a total of 113 patients were analyzed. The median age was 72.0 (IQR: 62.0-76.0) years; 41 (36.3%) and 72 (63.7%) were women and men, respectively. There were in 45 (39.8%) patients in the CI, 39 (34.5%) in the PI, and 29 (25.7%) in the NI groups, respectively. Single-variable analysis revealed significant relation to epiglottic inversion of Food Intake LEVEL Scale score, penetration-aspiration score with 3-mL thin liquid bolus, epiglottic vallecula and pyriform sinus residue, hyoid position and displacement during swallowing, pharyngeal inlet angle (PIA), epiglottis to posterior pharyngeal wall distance, and body mass index. Logistic regression analysis with complete epiglottic inversion as the dependent variable revealed the X coordinate at maximum hyoid elevation position during swallowing and PIA as significant explanatory variables. These results suggest that epiglottic inversion is constrained in patients with dysphagia who have poor head and neck alignment or posture and a narrow pharyngeal cavity just before swallowing.
Collapse
Affiliation(s)
- Taku Suzuki
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Haruka Hino
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Jin Magara
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan
| | - Makoto Inoue
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan.
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan.
- Oral Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan.
| |
Collapse
|
14
|
McGonagle D, David P, Macleod T, Watad A. Predominant ligament-centric soft-tissue involvement differentiates axial psoriatic arthritis from ankylosing spondylitis. Nat Rev Rheumatol 2023; 19:818-827. [PMID: 37919337 DOI: 10.1038/s41584-023-01038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Since the original description of spondyloarthritis 50 years ago, results have demonstrated similarities and differences between ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA). HLA-B27 gene carriage in axial inflammation is linked to peri-fibrocartilaginous sacroiliac joint osteitis, as well as to spinal peri-entheseal osteitis, which is often extensive and which provides a crucial anatomical and immunological differentiation between the AS and PsA phenotypes. Specifically, HLA-B27-related diffuse bone marrow oedema (histologically an osteitis) and bone marrow fatty corners detected via magnetic resonance imaging, as well as radiographic changes such as sacroiliitis, vertebral squaring, corner erosions and Romanus lesions, all indicate initial bone phenotypes in HLA-B27+ axial disease. However, in much of PsA with axial involvement, enthesitis primarily manifests in ligamentous soft tissue as 'ligamentitis', with characteristic lesions that include para-syndesmophytes and sacroiliac joint bony sparing. Like axial PsA, diffuse idiopathic skeletal hyperostosis phenotypes, which can be indistinguishable from PsA, exhibit a thoracic and cervical spinal ligamentous soft-tissue tropism, clinically manifesting as syndesmophytosis that is soft-tissue-centric, including paravertebral soft-tissue ossification and sacroiliac soft-ligamentous ossification instead of joint-cavity fusion. The enthesis bone and soft tissues have radically different immune cell and stromal compositions, which probably underpins differential responses to immunomodulatory therapy, especially IL-23 inhibition.
Collapse
Affiliation(s)
- Dennis McGonagle
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
| | - Paula David
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Tom Macleod
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Abdulla Watad
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Sunakawa J, Yano H, Kinjo M. Dysphagia with diffuse idiopathic skeletal hyperostosis. BMJ Case Rep 2023; 16:e242852. [PMID: 38035685 PMCID: PMC10689397 DOI: 10.1136/bcr-2021-242852] [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: 12/02/2023] Open
Affiliation(s)
- Junji Sunakawa
- Internal Medicine, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Hiroyuki Yano
- Internal Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Mitsuyo Kinjo
- Internal Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| |
Collapse
|
17
|
Zhou H, Xu H, Gong J, Li Z, Sun X. High Circulating FGF-23 and Its Relationship with Severity of Spinal Involvement in Diffuse Idiopathic Skeletal Hyperostosis. Calcif Tissue Int 2023; 113:526-531. [PMID: 37725126 DOI: 10.1007/s00223-023-01134-8] [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: 06/12/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
The primary objective of this study was to determine the role of fibroblast growth factor 23 (FGF-23) in the pathogenesis of diffuse idiopathic skeletal hyperostosis (DISH). A total of 61 patients with DISH and 61 age- and sex-matched control patients without DISH were included in this study. The serum FGF-23, creatinine, inorganic phosphate, calcium, albumin, albumin-adjusted calcium and alkaline phosphatase, and C-reactive protein were assessed in both groups. Based on the extent of ossification, DISH group was further divided into T-DISH and L-DISH subgroups. Data were comparatively analyzed between DISH and Non-DISH groups and among T-DISH, L-DISH, and Non-DISH groups, respectively. Besides, the number of ossification segments of all DISH patients was quantified and the correlation between the number of ossification segments and the serum concentration of FGF-23 was analyzed. The results revealed that serum FGF-23 was significantly higher in DISH group than in Non-DISH group, regardless of gender. Interestingly, serum Pi was significantly lower in DISH group than in Non-DISH group. Moreover, a significant difference in serum FGF-23 among T-DISH, L-DISH, and Non-DISH groups was also observed. In contrast to Non-DISH group, both T-DISH and L-DISH subgroups displayed significantly higher serum FGF-23 level. Although the mean value was relatively higher in L-DISH subgroup, no statistically significant difference was found between T-DISH and L-DISH subgroups. In addition, a moderately positive correlation was identified between the number of ossification segments and the serum level of FGF-23. It can be concluded that serum FGF-23 could serve as a positive biomarker for DISH and may play a significant role in ectopic ossification in DISH.
Collapse
Affiliation(s)
- Haicheng Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Hongpan Xu
- Department of Clinical Laboratory, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Zhongshan Road 321, Nanjing, 210008, China
| | - Jianmin Gong
- College of Life Science, Yangtze University, Jingzhou, China
| | - Zhiyang Li
- Department of Clinical Laboratory, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
| |
Collapse
|
18
|
Chen H, Zhou Q, Wang S, Pu X, Zhou H, Wang B, Zhu Z, Qiu Y, Sun X. Not All Osteophytes Are Located on the Right Side of the Vertebrae in Diffuse Idiopathic Skeletal Hyperostosis: A Quantitative Analysis in Relation to the Position of Aorta. Orthop Surg 2023; 15:2881-2888. [PMID: 37680188 PMCID: PMC10622269 DOI: 10.1111/os.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by osteophytes in the anterior vertebrae, and the presence of aorta may have an impact on their formation. However, the anatomical positional relationship between the aorta and osteophytes in patients with DISH remains controversial. This study aimed to evaluate the position of osteophytes in relation to aorta in DISH, and the influence of aortic pulsation on the formation of osteophytes from the perspective of morphology. METHODS We conducted a retrospective review of 101 patients diagnosed with DISH and symptomatic lumbar spinal stenosis between June 2018 and December 2021. A total of 637 segments with heterotopic ossification in DISH were used for quantitative measurements on CT scans. The Cartesian coordinate system was built up on the axial CT scans to reflect the relative position between aorta and osteophytes. Osteophytes were divided into adjacent aorta group (AD group) and non-adjacent aorta group (N-AD group). In terms of the morphology, osteophytes in the AD group were further divided into convex, flat, and concave types. The relative position between aorta and osteophytes, and the aorta-osteophyte distance and morphology of osteophytes were compared. Univariate analysis of variance was performed for multiple groups, and two independent-samples t-tests were used for two groups. RESULTS From T5 to L4, aorta gradually descended from left side to middle of vertebrae, and osteophytes gradually shifted from right side of vertebrae (T5-T10) to bilateral sides (T11-L4). Of 637 osteophytes in DISH, 60.1% (383/637) were in AD group, including convex type 0.6% (4/637), flat type 34.7% (221/637), and concave type 24.8% (158/637). The N-AD group accounted for 39.9% (254/637). Flat osteophytes were concentrated in T5-T12, while concave osteophytes in T11-L4. Overall, the aorta-osteophyte distance of concave type was significantly smaller than that of flat type. CONCLUSION Osteophytes are not always located on the right side of vertebrae, but move with the position of the descending aorta. Furthermore, the morphology of osteophytes varies by vertebral segment in DISH, which is related to aorta descending anteriorly in the spine.
Collapse
Affiliation(s)
- Haojie Chen
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingChina
| | - Sinian Wang
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Xiaojiang Pu
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Haicheng Zhou
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopaedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| |
Collapse
|
19
|
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 2023:S0949-2658(23)00277-4. [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] [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.
Collapse
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
| |
Collapse
|
20
|
Zhou H, Wang S, Wang N, Chen H, Wang B, Qiu Y, Zhu Z, Sun X. How does diffuse idiopathic skeletal hyperostosis affect the sagittal spinopelvic alignment in lumbar spinal stenosis patients? Clin Neurol Neurosurg 2023; 233:107940. [PMID: 37591038 DOI: 10.1016/j.clineuro.2023.107940] [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: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To compare the differences of spinopelvic morphology among patients with DISH, patients without DISH and normal elderly and to assess the impact of ossification extent on sagittal alignment. METHODS Patients with and without DISH aged > 50 years who required surgery because of lumbar spinal stenosis were enrolled in this cohort(DISH and Non-DISH groups). Also, we collected age-matched normal old outpatients as the control group(Normal group). According to ossification extent, DISH group were divided into two subgroups(T-DISH and L-DISH subgroups). Spinopelvic parameters were measured. Distribution differences of Roussouly classification were analyzed between DISH and Non-DISH group, T-DISH and L-DISH subgroup, respectively. Additionally, distribution difference of kyphotic apex vertebrae between T-DISH and L-DISH subgroup was also investigated. RESULTS A total of 429 patients (300 males and 129 females) were enrolled in our study, with a mean age of 64.1 ± 5.8 years. Compared to the Normal group, DISH and Non-DISH groups both had significantly higher CSVA, PT, OH, SVA, TPA and lower LL, SS, C7 Tilt, SSA, SPA. Compared to Non-DISH group, DISH group, regardless of ossification extent, had significantly higher T1 slope, CSVA, TK and SVA. Besides, T-DISH subgroup showed significant higher LL, PI, SS and SSA than L-DISH subgroup. There were significant differences of Roussouly classification distribution between T-DISH and L-DISH subgroup. In terms of kyphotic apex location, compared to relatively higher locations in T-DISH subgroup, L-DISH subgroup had apical locations predominantly in the lower thoracic. CONCLUSION Sagittal spinopelvic alignment is influenced by the presence of DISH and the extent of ossification. Patients with L-DISH have not only increased thoracic kyphosis and forward trunk, but also insufficient lumbar lordosis.
Collapse
Affiliation(s)
- Haicheng Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Sinian Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Nannan Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, China
| | - Haojie Chen
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Hirota R, Teramoto A, Yoshimoto M, Takashima H, Yasuda N, Tsukamoto A, Iesato N, Emori M, Iba K, Kawaharada N, Yamashita T. Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med 2023; 12:5412. [PMID: 37629454 PMCID: PMC10455897 DOI: 10.3390/jcm12165412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH.
Collapse
Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0808, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Arihiko Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| |
Collapse
|
23
|
Pini SF, Pariente E, Olmos JM, Martín-Millán M, Pascua R, Martínez-Taboada VM, Hernández JL. Diffuse idiopathic skeletal hyperostosis (DISH) and trabecular bone score (TBS) in postmenopausal women: The Camargo cohort. Semin Arthritis Rheum 2023; 61:152217. [PMID: 37186972 DOI: 10.1016/j.semarthrit.2023.152217] [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: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The potential relationship between diffuse idiopathic skeletal hyperostosis (DISH) and bone microstructure has not been studied in women. We aimed to assess the association between the trabecular bone score (TBS) and DISH in postmenopausal women, as well as the role of other parameters related to bone metabolism, such as bone mineral density (BMD), calciotropic hormones, and bone remodeling markers. METHODS Cross-sectional study, nested in a prospective population-based cohort (Camargo cohort). Clinical covariates, DISH, TBS, vitamin D, parathormone, BMD and serum bone turnover markers, were analyzed. RESULTS We have included 1545 postmenopausal women (mean age, 62±9 years). Those with DISH (n = 152; 8.2%) were older and had a significantly higher prevalence of obesity, metabolic syndrome, hypertension, and type 2 diabetes mellitus (p<0.05). Moreover, they had lower TBS values (p = 0.0001) despite having a higher lumbar spine BMD (p<0.0001) and a higher prevalence of vertebral fractures than women without DISH (28.6% vs. 15.1%; p = 0.002). When analyzing DISH through Schlapbach grades, women without DISH had a median TBS value consistent with a normal trabecular structure while the values for women with DISH from grades 1 to 3 were consistent with a partially degraded trabecular structure. Women with vertebral fractures and DISH had a mean TBS corresponding to a degraded trabecular structure (1.219±0.1). After adjusting for confounders, the estimated TBS means were 1.272 (1.253-1.290) in the DISH group, and 1.334 (1.328-1.339) in the NDISH group (p<0.0001). CONCLUSION An association between DISH and TBS has been shown in postmenopausal women, in which hyperostosis has been significantly and consistently related to trabecular degradation and, therefore, to deterioration in bone quality after adjusting for confounding variables.
Collapse
Affiliation(s)
- Stefanie F Pini
- Hospital at Home Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Emilio Pariente
- Camargo Interior Primary Care Center, Servicio Cántabro de Salud, Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain.
| | - José M Olmos
- Internal Medicine Department. Bone Metabolism Unit, Hospital Universitario Marqués de Valdecilla, Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Marta Martín-Millán
- Internal Medicine Department. Bone Metabolism Unit, Hospital Universitario Marqués de Valdecilla, Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Raquel Pascua
- Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Victor M Martínez-Taboada
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - José L Hernández
- Internal Medicine Department. Bone Metabolism Unit, Hospital Universitario Marqués de Valdecilla, Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| |
Collapse
|
24
|
Zervos TM, Jago SS, Erwood MS, Basheer A, Lee IY, Lubin FD, Schultz L, Walters BC. A Multicenter Allelic Analysis of Diffuse Idiopathic Skeletal Hyperostosis: Nature Versus Nurture? Neurosurgery 2023; 93:348-357. [PMID: 36802217 PMCID: PMC10586868 DOI: 10.1227/neu.0000000000002417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/20/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is an incompletely defined disease process with no known unifying pathophysiological mechanism. OBJECTIVE To our knowledge, no genetic studies have been performed in a North American population. To summarize genetic findings from previous studies and to comprehensively test for these associations in a novel and diverse, multi-institutional population. METHODS Cross-sectional, single nucleotide polymorphism (SNP) analysis was performed in 55 of 121 enrolled patients with DISH. Baseline demographic data were available on 100 patients. Based on allele selection from previous studies and related disease conditions, sequencing was performed on COL11A2, COL6A6, fibroblast growth factor 2 gene, LEMD3, TGFB1, and TLR1 genes and compared with global haplotype rates. RESULTS Consistent with previous studies, older age (mean 71 years), male sex predominance (80%), a high frequency of type 2 diabetes (54%), and renal disease (17%) were observed. Unique findings included high rates of tobacco use (11% currently smoking, 55% former smoker), a higher predominance of cervical DISH (70%) relative to other locations (30%), and an especially high rate of type 2 diabetes in patients with DISH and ossification of the posterior longitudinal ligament (100%) relative to DISH alone (100% vs 47%, P < .001). Compared with global allele rates, we found higher rates of SNPs in 5 of 9 tested genes ( P < .05). CONCLUSION We identified 5 SNPs in patients with DISH that occurred more frequently than a global reference. We also identified novel environmental associations. We hypothesize that DISH represents a heterogeneous condition with both multiple genetic and environmental influences.
Collapse
Affiliation(s)
- Thomas M. Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Silvienne Sint Jago
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew S. Erwood
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ian Y. Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Farah D. Lubin
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, Michigan, USA
| | - Beverly C. Walters
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
25
|
Tung NTC, Yahara Y, Yasuda T, Seki S, Suzuki K, Watanabe K, Makino H, Kamei K, Kawaguchi Y. Sacroiliac Joint Variation in Patients With Ossification of the Posterior Longitudinal Ligament. Global Spine J 2023; 13:1474-1480. [PMID: 34510951 PMCID: PMC10448107 DOI: 10.1177/21925682211037593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Ossification of the posterior longitudinal ligament (OPLL) reveals heterotopic ossification in the spinal ligament. OPLL also tends to ossify ligaments and entheses throughout the body. However, hallmarks of sacroiliac (SI) joint ossification and its variation in OPLL have not been clarified. Here, we investigated the morphological changes in SI joints in individuals with and without OPLL. METHODS We included 240 age- and sex-matched patients (OPLL+, 120; OPLL-, 120) in the study. SI joint variations were classified into 4 types: Type 1, normal or small peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophyte formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. Type 4 was further divided into 3 subgroups as previously described. Interactions between the ossified spinal region in OPLL and morphological changes in the SI joint were evaluated. RESULTS SI joint ankylosis occurs more frequently in patients with OPLL (51.7%) than in those without (non-OPLL) (33.3%). The SI joint vacuum phenomenon (49.2%) was the main finding in non-OPLL. SI joint ankylosis in OPLL was characterized by anterior bridging and intra-articular fusion. OPLL patients with multilevel ossification tend to develop degeneration and ankylosis of the SI joints. CONCLUSIONS OPLL conferred a high risk of SI joint ossification compared with non-OPLL, and patients with extensive ossification had a higher rate of SI joint ankylosis. Understanding SI joint variation could help elucidate OPLL etiology and clarify the phenotypic differences in the SI joint between OPLL and other spinal disorders.
Collapse
Affiliation(s)
- Nguyen Tran Canh Tung
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Trauma and Orthopaedic Surgery, Vietnam Military Medical University, Hanoi, Vietnam
| | - Yasuhito Yahara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Molecular and Medical Pharmacology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kenta Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
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: 0] [Impact Index Per Article: 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.
Collapse
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.
| |
Collapse
|
28
|
Fournier DE, Veras MA, Brooks CR, Quinonez D, Millecamps M, Stone LS, Séguin CA. Stiffness and axial pain are associated with the progression of calcification in a mouse model of diffuse idiopathic skeletal hyperostosis. Arthritis Res Ther 2023; 25:72. [PMID: 37120576 PMCID: PMC10148510 DOI: 10.1186/s13075-023-03053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/20/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by progressive calcification of spinal tissues; however, the impact of calcification on pain and function is poorly understood. This study examined the association between progressive ectopic spine calcification in mice lacking equilibrative nucleoside transporter 1 (ENT1-/-), a preclinical model of DISH, and behavioral indicators of pain. METHODS A longitudinal study design was used to assess radiating pain, axial discomfort, and physical function in wild-type and ENT1-/- mice at 2, 4, and 6 months. At endpoint, spinal cords were isolated for immunohistochemical analysis of astrocytes (GFAP), microglia (IBA1), and nociceptive innervation (CGRP). RESULTS Increased spine calcification in ENT1-/- mice was associated with reductions in flexmaze exploration, vertical activity in an open field, and self-supporting behavior in tail suspension, suggesting flexion-induced discomfort or stiffness. Grip force during the axial stretch was also reduced in ENT1-/- mice at 6 months of age. Increased CGRP immunoreactivity was detected in the spinal cords of female and male ENT1-/- mice compared to wild-type. GFAP- and IBA1-immunoreactivity were increased in female ENT1-/- mice compared to wild-type, suggesting an increase in nociceptive innervation. CONCLUSION These data suggest that ENT1-/- mice experience axial discomfort and/or stiffness and importantly that these features are detected during the early stages of spine calcification.
Collapse
Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, The University of Western Ontario, London, ON, N6A 5B9, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Matthew A Veras
- Bone and Joint Institute, The University of Western Ontario, London, ON, N6A 5C1, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Courtney R Brooks
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Diana Quinonez
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Magali Millecamps
- Faculty of Dentistry, McGill University, Montreal, QC, H3A 1G1, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, H3G 0G1, Canada
| | - Laura S Stone
- Faculty of Dentistry, McGill University, Montreal, QC, H3A 1G1, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, H3G 0G1, Canada
- Faculty of Medicine, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Cheryle A Séguin
- Bone and Joint Institute, The University of Western Ontario, London, ON, N6A 5C1, Canada.
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada.
| |
Collapse
|
29
|
Phang SY, Barrett C, Purcell M. A radiological study of the natural history of diffuse idiopathic skeletal hyperostosis (DISH): a story of incomplete fusion. Br J Neurosurg 2023:1-10. [PMID: 37096425 DOI: 10.1080/02688697.2023.2197494] [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: 04/26/2023]
Abstract
Introduction: DISH is an ankylosing disease, when fractured can be challenging to manage. A retrospective radiological study was conducted to evaluate the natural history and radiological characteristics of DISH on Computed tomography (CT).Methods: Paired CT scans with DISH that are separated at least two years apart were used to perform the following radiological measurements: Degree of disc space fusion, Osteophyte and vertebral body linear attenuation coefficients (LAC), and Osteophyte axial area size and location.Results: 164 patients were analysed with a mean duration of 4.49 years between scans. 38.14% (442/1159) of disc spaces had at least partial calcification. Most osteophytes were right sided before becoming more circumferential over time. The average fusion score was 54.17. Most of the changes in fusion occurred in the upper and lower thoracic regions. The thoracic region when compared to the lumbar region had a greater proportion of its disc spaced being fully fused. Disc level osteophyte areas were larger than Body level osteophytes. Disc osteophytes size growth rate drops over time from 10.89mm2/year in Stage 1 to 3.56mm2/year in Stage 3. Stage 3 disc spaces (-11.01HU/year) was also found to have had a reduction in their LAC over time when compared to Stage 1 disc spaces (17.04HU/year). This change in osteophyte LAC was not mirrored in the change in vertebral body LAC. We predict that the age of onset and complete thoracolumbar ankylosis of DISH to be 17.96 years and 100.59 years, respectively.Conclusion: DISH ankylosis of the spine a slow process that starts in the mid to lower thoracic region before extending cranially and caudally. After the bridging osteophyte has fully formed, remodelling of the osteophyte occurs.
Collapse
Affiliation(s)
- See Yung Phang
- Neurosurgery department, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
| | - Christopher Barrett
- Neurosurgery department, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
| | - Margaret Purcell
- National Spinal Injuries Unit, Queen Elizabeth University Hospital Glasgow, Glasgow, Scotland
| |
Collapse
|
30
|
Dong Y, Li J, Yang K, Guo S, Zhai J, Zhao Y. Thoracic spondylotic myelopathy in diffuse idiopathic skeletal hyperostosis: a comparative study. J Orthop Surg Res 2023; 18:242. [PMID: 36966324 PMCID: PMC10039576 DOI: 10.1186/s13018-023-03723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND To explore the characteristics and clinical management of thoracic spinal stenosis with diffuse idiopathic skeletal hyperostosis (DISH). METHODS The patients diagnosed with thoracic spondylotic myelopathy who underwent spinal decompression and fusion surgery in a single center between 2012 and 2020 were retrospectively analyzed. All the patients were followed up for at least 2 years. Patients were classified into DISH and non-DISH groups. Demographic, radiographic and clinical parameters were compared between the two groups. RESULTS A total of 100 thoracic spondylotic myelopathy patients were included in the study. 22 patients were diagnosed with DISH. The proportion of male patients in the DISH group was higher, and the average BMI was larger. The incidence of upper thoracic vertebrae with ossification of posterior longitudinal ligament (OPLL) (P < 0.05) and lumbar spine with ossification of ligamentum flavum (OLF) was higher (P < 0.05) in DISH the group. The proportion of patients received staged surgery is higher in the DISH group (P < 0.1). There were no significant differences between the two groups in the amount of surgical bleeding, the ratio of cerebrospinal fluid leakage, the time duration of drainage tube placement and the JOA scores. CONCLUSION Thoracic spinal stenosis with DISH occurred more in male patients with larger BMI. The posterior decompression and fusion surgery could achieve comparable satisfying clinical outcomes between DISH and non-DISH patients. More proportion of patients received staged surgery in the DISH group; the underline mechanism may be DISH caused more OPLL in the upper thoracic spine and more OLF in the lumbar spine because of mechanical stress.
Collapse
Affiliation(s)
- YuLei Dong
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jiahao Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Kaili Yang
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Shigong Guo
- Department of Rehabilitation Medicine, Southmead Hospital, Bristol, UK
| | - Jiliang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yu Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan Dongdan, Dongcheng District, Beijing, 100730, People's Republic of China.
| |
Collapse
|
31
|
Early stages of diffuse idiopathic skeletal hyperostosis (DISH) and chronic inflammation: the Camargo Cohort Study. Clin Rheumatol 2023:10.1007/s10067-023-06574-z. [PMID: 36933072 DOI: 10.1007/s10067-023-06574-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION/OBJECTIVES DISH has traditionally been considered a non-inflammatory rheumatic disorder. Currently, an inflammatory component has been theorized in the early phases of this condition (EDISH). The study is aimed at investigating a possible relationship between EDISH and chronic inflammation. METHOD Analytical-observational study: participants from the Camargo Cohort Study were enrolled. We collected clinical, radiological, and laboratory data. C-reactive protein (CRP), albumin-to-globulin ratio (AGR), and triglyceride-glucose (TyG) index were assessed. EDISH was defined by Schlapbach's scale grades I or II. A fuzzy matching with tolerance factor = 0.2 was performed. Subjects without ossification (NDISH), sex- and age-matched with cases (1:4), acted as controls. Definite DISH was an exclusion criterion. Multivariable analyses were performed. RESULTS We evaluated 987 persons (mean age 64 ± 8 years; 191 cases with 63.9% women). EDISH subjects presented more frequently obesity, T2DM, MetS, and the lipid pattern [↑TG ↓TC]. TyG index and alkaline phosphatase (ALP) were higher. Trabecular bone score (TBS) was significantly lower (1.310 [0.2] vs. 1.342 [0.1]; p = 0.025). CRP and ALP showed the highest correlation (r = 0.510; p = 0.0001) at lowest TBS level. AGR was lower, and its correlations with ALP (r = - 0.219; p = 0.0001) and CTX (r = - 0.153; p = 0.022), were weaker or non-significant in NDISH. After adjustment for potential confounders, estimated CRP means for EDISH and NDISH were 0.52 (95% CI: 0.43-0.62) and 0.41 (95% CI: 0.36-0.46), respectively (p = 0.038). CONCLUSIONS EDISH was associated with chronic inflammation. Findings revealed an interplay between inflammation, trabecular impairment, and the onset of ossification. Lipid alterations were similar to those observed in chronic-inflammatory diseases. Key Points • An inflammatory component has been theorized in early stages of DISH (EDISH) • In EDISH group compared to non-DISH, we observed significantly higher correlations between biomarkers and some relevant variables. In particular, with alkaline phosphatase (ALP) and with trabecular bone score (TBS) • EDISH has shown to be associated with chronic inflammation • The lipid alterations observed in the EDISH group were similar to those observed in chronic-inflammatory diseases.
Collapse
|
32
|
Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study. Sci Rep 2023; 13:1849. [PMID: 36725891 PMCID: PMC9892029 DOI: 10.1038/s41598-023-28946-w] [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] [Received: 10/26/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.
Collapse
|
33
|
Ruan S, Song X, Xu X, Lu F, Yuan C, Zhang B, Tung TH, Hong D. Is spinal sagittal alignment of diffuse idiopathic skeletal hyperostosis relevant to thoracolumbar pain? A controlled study. BMC Musculoskelet Disord 2022; 23:1134. [PMID: 36575424 PMCID: PMC9793584 DOI: 10.1186/s12891-022-06084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The extension of diffuse idiopathic skeletal hyperostosis (DISH) from the low thoracic spine to the lumbar spine result in adjustment of spinal sagittal alignment in surgical patients. The aim of this study was to investigate changes in sagittal alignment and back pain in the thoracolumbar spine in nonsurgical DISH and control participants selected from a radiological database. METHODS Participants in the DISH and the control group were selected by searching for "DISH or degenerative changes in the thoracic spine" in the radiology database of Taizhou Hospital between 2018 and 2021 using Resnick and Niwayama's criteria. The subjects with spinal tumors, previous spinal surgery, vertebral fractures, inflammatory diseases, poor-quality radiographs, or loss of follow-up were excluded. Demographic and clinical characteristics were recorded retrospectively via the hospital information system and telephone follow-up. Segmental disc angles (SDAs), lumbar lordosis (LL), and bridge scores were analyzed using images of three-dimensional CT. RESULTS The final participants consisted of 51 individuals with DISH (DISH group) and 102 individuals without DISH (control group). Depending on the presence of thoracolumbar pain, the DISH group was divided into the DISH group with thoracolumbar pain (DISH+Pain) and the DISH group without thoracolumbar pain (DISH-Pain). The LL and SDAs of T11-T12 and T12-L1 were significantly greater in the DISH group than in the control group. In addition, the SDA of L1-L2 was significantly smaller in the DISH+Pain group than in the DISH-Pain group, whereas there was no significant difference in lumbar lordosis between the DISH+Pain group and the DISH-Pain group. The bridge scores in DISH+Pain group was larger in T10-T11 (p = 0.01) and L1-L2 (p < 0.01) spine segments than those in DISH-Pain group. CONCLUSION The extension of DISH from thoracic to lumbar spine may increase lumbar lordosis and SDAs in the thoracolumbar spine. The DISH patients with more bony bridging and small L1-L2 SDA may be more likely have thoracolumbar pain. Adjustment of sagittal alignment of the spine in the development of DISH may be of clinical importance.
Collapse
Affiliation(s)
- Shengyu Ruan
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China ,Bone Metabolism and Development Research Center, Enze Medical Center, Taizhou, China
| | - Xiaoting Song
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China ,Bone Metabolism and Development Research Center, Enze Medical Center, Taizhou, China
| | - Xianquan Xu
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China
| | - Fangying Lu
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China ,Bone Metabolism and Development Research Center, Enze Medical Center, Taizhou, China
| | - Chiting Yuan
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China ,Bone Metabolism and Development Research Center, Enze Medical Center, Taizhou, China
| | - Binhao Zhang
- grid.452858.60000 0005 0368 2155Department of Radiology, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China
| | - Tao-Hsin Tung
- Department of Clinical Research, Enze Medical Center, Taizhou, China
| | - Dun Hong
- grid.452858.60000 0005 0368 2155Department of Orthopedics, Taizhou Hospital affiliated to Wenzhou Medical University, Linhai, China ,Bone Metabolism and Development Research Center, Enze Medical Center, Taizhou, China
| |
Collapse
|
34
|
UMEGAKI M, FUKUNAGA T, NINOMIYA K, MATSUMOTO K, SASAKI M. Diffuse Idiopathic Skeletal Hyperostosis with Severely Displaced Spine Fracture Managed with Posterior Approach Alone: Case Reports and Literature Review. NMC Case Rep J 2022; 9:401-405. [PMID: 36589779 PMCID: PMC9771471 DOI: 10.2176/jns-nmc.2022-0209] [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: 06/16/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition in which minor trauma can cause extremely unstable vertebral fractures. Spinal fractures associated with DISH are prone to instability due to the large moment of lever arm and secondary neurological deterioration; hence, surgical internal fixation is considered necessary. On the other hand, some reports suggest that patients with DISH have a high osteogenic potential. In this report, we describe three patients with DISH. These patients had spinal injuries that resulted in a large gap, for which anterior fixation with bone graft would generally be considered due to comminuted fractures. However, we achieved good bony fusion with posterior fixation alone, without forcible correction.
Collapse
Affiliation(s)
- Masao UMEGAKI
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | | | - Koshi NINOMIYA
- Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan
| | | | - Manabu SASAKI
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Osaka, Japan,Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
35
|
Page PS, Greeneway GP, Lake WB, Brooks NP, Josiah DT, Hanna AS, Resnick DK. Outcomes following conservative treatment of extension fractures in the setting of diffuse idiopathic skeletal hyperostosis: is external orthosis alone a reasonable option? J Neurosurg Spine 2022; 37:927-931. [PMID: 35932260 DOI: 10.3171/2022.6.spine22551] [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: 05/14/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes. METHODS A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported. RESULTS Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported. CONCLUSIONS Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.
Collapse
Affiliation(s)
- Paul S. Page
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Wendell B. Lake
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Nathaniel P. Brooks
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Darnell T. Josiah
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Amgad S. Hanna
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Daniel K. Resnick
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| |
Collapse
|
36
|
A case of diffuse idiopathic hyperostosis of bone (DISH) in a patient on hemodialysis. CEN Case Rep 2022; 12:226-229. [PMID: 36401745 PMCID: PMC10151430 DOI: 10.1007/s13730-022-00755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory progressive disease resulting in ossification of the anterior longitudinal ligament of the spine and tendons. Herein, we describe a case of DISH in a patient on long-term hemodialysis. The patient was a 79-year-old man undergoing hemodialysis for chronic kidney disease due to diabetic nephropathy. He presented to the emergency department complaining of back pain after a slip and fall. Radiographs revealed bamboo spine-like findings, extending from the cervical to the lumbar spine. Computed tomography and magnetic resonance imaging revealed a compression fracture of thoracic vertebra 12, with abnormal ossification of the anterior longitudinal ligament. Inter-vertebral vertical osseous bridges were also observed at the cervical 7 and lumbar 2 vertebrae. There was no obvious spinal cord compression. Leukocytosis and C-reactive protein levels were not elevated and the human leukocyte type antigen HLA-B27 test was negative. Based on this finding, a diagnosis of DISH was made. In the absence of neurological findings, the patient was treated conservatively. Our findings show an overlap between the clinical features of DISH and those of hemodialysis patients, including older age, male sex, and diabetes.
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Choi JH, Kim HR, Song KH. Musculoskeletal complications in patients with diabetes mellitus. Korean J Intern Med 2022; 37:1099-1110. [PMID: 36300322 PMCID: PMC9666255 DOI: 10.3904/kjim.2022.168] [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: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal conditions are common in patients with diabetes. Several musculoskeletal disorders are viewed as chronic complications of diabetes because epidemiological studies have revealed high correlations between such complications and diabetes, but the pathophysiological links with diabetes remains unclear. Genetic predispositions, shared risk factors, microvascular impairments, progressive accumulation of advanced glycation end-products, and diabetic neuropathy may underlie the development of musculoskeletal disorders. Musculoskeletal complications of diabetics have received less attention than life-threatening microvascular or macrovascular complications. Here, we review several diabetic musculoskeletal complications with a focus on the clinical importance of early recognition and management, which would improve quality of life and physical function.
Collapse
Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| |
Collapse
|
39
|
Couto AR, Parreira B, Power DM, Pinheiro L, Madruga Dias J, Novofastovski I, Eshed I, Sarzi-Puttini P, Pappone N, Atzeni F, Verlaan JJ, Kuperus J, Bieber A, Ambrosino P, Kiefer D, Khan MA, Mader R, Baraliakos X, Bruges-Armas J. Evidence for a genetic contribution to the ossification of spinal ligaments in Ossification of Posterior Longitudinal Ligament and Diffuse idiopathic skeletal hyperostosis: A narrative review. Front Genet 2022; 13:987867. [PMID: 36276944 PMCID: PMC9586552 DOI: 10.3389/fgene.2022.987867] [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: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Ossification of the Posterior Longitudinal Ligament (OPLL) are common disorders characterized by the ossification of spinal ligaments. The cause for this ossification is currently unknown but a genetic contribution has been hypothesized. Over the last decade, many studies on the genetics of ectopic calcification disorders have been performed, mainly on OPLL. Most of these studies were based on linkage analysis and case control association studies. Animal models have provided some clues but so far, the involvement of the identified genes has not been confirmed in human cases. In the last few years, many common variants in several genes have been associated with OPLL. However, these associations have not been at definitive levels of significance and evidence of functional significance is generally modest. The current evidence suggests a multifactorial aetiopathogenesis for DISH and OPLL with a subset of cases showing a stronger genetic component.
Collapse
Affiliation(s)
- Ana Rita Couto
- Hospital de Santo Espirito da Ilha Terceira EPER, SEEBMO, Angra do Heroísmo, Portugal
- CHRC Campus Nova Medical School, Lisboa, Portugal
| | - Bruna Parreira
- Hospital de Santo Espirito da Ilha Terceira EPER, SEEBMO, Angra do Heroísmo, Portugal
- CHRC Campus Nova Medical School, Lisboa, Portugal
| | - Deborah M. Power
- University of Algarve, Center of Marine Science (CCMAR), Faro, Portugal
| | - Luís Pinheiro
- Hospital de Santo Espirito da Ilha Terceira EPER, Orthopedics Service, Angra do Heroísmo, Portugal
| | - João Madruga Dias
- Centro Hospitalar Do Medio Tejo EPE Unidade de Torres Novas, Rheumatology Department, Santarém, Portugal
- CHRC Campus Nova Medical School, EpiDoc Research Unit, CEDOC, Lisboa, Portugal
| | | | | | | | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Telese Terme Institute, Pavia, Italy
| | - Fabiola Atzeni
- Universita Degli Studi di Messina, Rheumatology Unit, Clinical and Experimental Medicine, Messina, Italy
| | - Jorrit-Jan Verlaan
- University Medical Centre, Department of Orthopedics, Utrecht, Netherlands
| | | | - Amir Bieber
- Emek Medical Center, Rheumatology Unit, Afula, Israel
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Pavia, Italy
| | - David Kiefer
- Ruhr-Universitat Bochum, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | | | - Reuven Mader
- Emek Medical Center, Rheumatology Unit, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Ruhr University Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | | | - Jácome Bruges-Armas
- Hospital de Santo Espirito da Ilha Terceira EPER, SEEBMO, Angra do Heroísmo, Portugal
- CHRC Campus Nova Medical School, Lisboa, Portugal
- *Correspondence: Jácome Bruges-Armas,
| |
Collapse
|
40
|
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: 11] [Impact Index Per Article: 5.5] [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.
Collapse
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
| |
Collapse
|
41
|
Zhang B, Chen G, Chen X, Chen Z, Sun C. Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071652. [PMID: 35885556 PMCID: PMC9324076 DOI: 10.3390/diagnostics12071652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been evaluated as a potential risk factor of poor surgical outcomes for lumbar spinal stenosis, whereas the influence of DISH on neuroimaging characteristics and postoperative prognosis of patients with thoracic myelopathy has not been established. Therefore, this study aimed to shed light on this issue. Methods: A monocentric study enrolled 167 eligible patients with thoracic ossification of ligamentum flavum (TOLF), who were followed up for at least 2 years. Clinico-radiological parameters and surgical outcomes were compared between the DISH+ and DISH− groups before and after propensity matching. Subgroup analysis was conducted to compare the functional outcomes between mild DISH (M-DISH) and moderately severe DISH (MS-DISH) groups. Results: Fifty-eight patients were diagnosed as DISH, and its prevalence was 34.7%. Patients with DISH presented with older age, more males, taller stature, heavier weight, more commonly diffuse-type TOLF (p < 0.05). The DISH group showed significantly worse recovery rate (RR) at the final follow-up before and after propensity matching (p < 0.01), and slightly lower preoperative VAS, higher postoperative VAS and lower VAS reduction, despite not reaching the significant differences. Subgroup analysis demonstrated that the M-DISH group was associated with the lower mJOA score (p = 0.01) and RR at the final follow-up (p = 0.001), and tended to present higher preoperative VAS than the MS-DISH group. Conclusions: DISH has a significant predisposition to the elderly males with diffuse-type TOLF. Although the presence of M-DISH might bring about a suboptimal surgical outcome, both DISH and non-DISH patients experienced good neurological function improvements and pain relief through thoracic posterior decompression.
Collapse
Affiliation(s)
- Baoliang Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Xi Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; (B.Z.); (G.C.); (X.C.)
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing 100191, China
- Correspondence: (Z.C.); (C.S.)
| |
Collapse
|
42
|
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: 16] [Impact Index Per Article: 8.0] [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).
Collapse
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
| |
Collapse
|
43
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
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
|
45
|
Xu L, Qian Z, Wang S, Wang R, Pu X, Yang B, Zhou Q, Du C, Chen Q, Feng Z, Xu L, Zhu Z, Qiu Y, Sun X. Galectin-3 Enhances Osteogenic Differentiation of Precursor Cells From Patients With Diffuse Idiopathic Skeletal Hyperostosis via Wnt/β-Catenin Signaling. J Bone Miner Res 2022; 37:724-739. [PMID: 35064940 DOI: 10.1002/jbmr.4508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory skeletal disease characterized by the progressive ectopic ossification and calcification of ligaments and enthuses. However, specific pathogenesis remains unknown. Bone marrow mesenchymal stem cells (BMSCs) are a major source of osteoblasts and play vital roles in bone metabolism and ectopic osteogenesis. However, it is unclear whether BMSCs are involved in ectopic calcification and ossification in DISH. The current study aimed to explore the osteogenic differentiation abilities of BMSCs from DISH patients (DISH-BMSCs). Our results showed that DISH-BMSCs exhibited stronger osteogenic differentiation abilities than normal control (NC)-BMSCs. Human cytokine array kit analysis showed significantly increased secretion of Galectin-3 in DISH-BMSCs. Furthermore, Galectin-3 downregulation inhibited the increased osteogenic differentiation ability of DISH-BMSCs, whereas exogenous Galectin-3 significantly enhanced the osteogenic differentiation ability of NC-BMSCs. Notably, the increased Galectin-3 in DISH-BMSCs enhanced the expression of β-catenin as well as TCF-4, whereas attenuation of Wnt/β-catenin signaling partially alleviated Galectin-3-induced osteogenic differentiation and activity in DISH-BMSCs. In addition, our results noted that Galectin-3 interacted with β-catenin and enhanced its nuclear accumulation. Further in vivo studies showed that exogenous Galectin-3 enhanced ectopic bone formation in the Achilles tendon in trauma-induced rats by activating Wnt/β-catenin signaling. The current study indicated that enhanced osteogenic differentiation of DISH-BMSCs was mainly attributed to the increased secretion of Galectin-3 by DISH-BMSCs, which enhanced β-catenin expression and its nuclear accumulation. Our study helps illuminate the mechanisms of pathological osteogenesis and sheds light on the possible development of potential therapeutic strategies for DISH treatment. © 2022 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Liang Xu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhuang Qian
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sinian Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Xiaojiang Pu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Yang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qingshuang Zhou
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Changzhi Du
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Quanchi Chen
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhenhua Feng
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Leilei Xu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xu Sun
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
46
|
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.
Collapse
|
47
|
OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:3981-3988. [DOI: 10.1093/rheumatology/keac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/19/2022] [Indexed: 11/12/2022] Open
|
48
|
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
| |
Collapse
|
49
|
Littlejohn GO. Historical bioarcheological aspects of diffuse idiopathic skeletal hyperostosis in humans. Semin Arthritis Rheum 2021; 52:151942. [PMID: 34998578 DOI: 10.1016/j.semarthrit.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify diffuse idiopathic skeletal hyperostosis (DISH) in the human bioarcheological record to seek out temporal, geographic and dietary information to enhance better understanding of this common condition. MATERIALS AND METHODS A review of available literature was conducted. RESULTS DISH has been identified in hominin populations over millions of years, including several different human species. The distribution of DISH in ancient populations is diverse, both temporally and geographically. Where available, dietary intake of subjects with DISH, in contrast to those without DISH, suggests that metabolic factors associate with DISH. CONCLUSION DISH is a ubiquitous human disorder over the ages. Metabolic factors appear important in ancient populations of those with DISH.
Collapse
Affiliation(s)
- Geoffrey O Littlejohn
- Emeritus Director Monash Health Rheumatology, Adjunct Clinical Professor, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
50
|
Zamora AC, Tallman SD. The role of diffuse idiopathic skeletal hyperostosis (DISH) in positive identification. J Forensic Sci 2021; 67:877-888. [DOI: 10.1111/1556-4029.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alyssa C. Zamora
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
| | - Sean D. Tallman
- Department of Anatomy & Neurobiology Boston University School of Medicine Boston USA
- Department of Anthropology Boston University Boston USA
| |
Collapse
|