A Comparison of Cervical and Thoracolumbar Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis-A Nationwide Multicenter Study

Cervical spine fracture in diffuse idiopathic skeletal hyperostosis: A bibliometric analysis

Objective

The study aimed to assess and investigate cervical spine fracture in diffuse idiopathic skeletal hyperostosis and to identify research trends in cervical spine fracture in diffuse idiopathic skeletal hyperostosis in countries around the world using bibliometric analysis.

Method

We examined bibliometric data obtained from the Scopus database collection for the periods 1 January 2000 and 1 January 2022. Authors, institutions, nations, publications, keywords, and references were noted and analyzed. The total number of research articles published on the subject of diffuse idiopathic skeletal hyperostosis was used to calculate the amount of research on that subject undertaken in the study period. A sample of the publication data collected from the Scopus database was then analyzed using the Bibliometric program and used to develop a relationship chart using the Bibliometrix and VOSviewer programs.

Results

The number of citations was assumed to be a qualitative measure of the publication. We estimated the impact of the research using several metrics, including the H-index, in the bibliometric analysis of authors, geographic areas, institutes, and references. A total of 52 studies related to cervical spine fractures in diffuse idiopathic skeletal hyperostosis were identified. Only 5.12% of those studies were cited in other publications, for a total of 1410 citations in publications by 342 authors, of whom only two authors had published a single study. Co-authorships occurred at 7.273%. Diseases common in elderly males were often studied retrospectively, and "Diffuse Idiopathic Skeletal Hyperostosis" was a frequently mentioned keyword.

Conclusion

The findings of this study provide insights into authors, institutions, key publications, and research trends related to diffuse idiopathic skeletal hyperostosis and can potentially serve as a guide for further studies in the field. The bibliometric analysis of cervical spine fractures in patients with diffuse idiopathic skeletal hyperostosis highlights important contributors, influential papers, geographical trends, and study characteristics in this area of research.

A Multicenter Allelic Analysis of Diffuse Idiopathic Skeletal Hyperostosis: Nature Versus Nurture?

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.

Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture

STUDY DESIGN

Retrospective multicenter study.

OBJECTIVE

The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures.

METHODS

The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score-matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury.

RESULTS

Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality.

CONCLUSIONS

The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study

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.

Is spinal sagittal alignment of diffuse idiopathic skeletal hyperostosis relevant to thoracolumbar pain? A controlled study

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.

Unstable fracture of fusion mass in old healed tuberculous kyphosis: Case report

Introduction and importance

Old healed spinal tuberculosis sometimes makes bony ankylosis with kyphotic deformity. This bony ankylosis with adjacent vertebra is like ankylosing spinal disorders (ASDs) such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis. There is lots of report which revealed that conservative management might be failed in thoracolumbar fracture in ASDs. However, there is no report which shows surgical treatment was finally done because conservative management was failed in fracture healing of fusion mass caused by old spinal tuberculosis.

Case presentation

A 68 year-old male patient has suffered from spinal tuberculosis about fifty years ago and then has bony kyphotic ankylosis. He fell off a ladder and was conducted conservative treatment under diagnosis of a sprain at a doctor's office. He was diagnosed with fracture of fusion mass after computed tomography and magnetic resonance image scans in our hospital due to persistent back pain. At first, he refused operation strongly, but underwent eventually posterior fixation without anterior support and angle correction for persistent pain and fracture nonunion. We finally achieved bone union after postoperative nine months.

Clinical discussion

The characteristics of old healed spinal tuberculosis with kyphotic deformity is similar to that of ASDs. The spine fractures among the patients with ASDs can be easily missed. So, Checking whole spine CT or MRI is recommended for fracture screening to ASD patients with back or neck pain after trauma. For unstable AOSpine type B- or C-type injuries, conservative management is not recommended. This recommendations should also apply to patients with spinal tuberculosis.

Conclusion

In patients with bony kyphotic ankylosis due to spinal tuberculosis, minor trauma can cause unstable fracture. If there's found unstable fracture, surgery should be underwent as soon as possible for preventing neurologic deficits. Hence, we would like to report this case with literature reviews.

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Old healed spinal tuberculosis sometimes makes bony ankylosis with kyphotic deformity

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patients with kyphotic deformity due to old healed spinal tuberculosis have an even minor trauma, CT or MRI should be recommended

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If there’s found unstable fracture, surgery should be underwent as soon as possible for preventing neurologic deficits

Association between diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in patients with cervical myelopathy: a retrospective observational study

Background

Diffuse idiopathic skeletal hyperostosis (DISH) is a structural abnormality of the thoracic spine that is known to impair posture. However, the relationship between DISH and sagittal balance in the whole spine is unclear. The aims of this study were to investigate the prevalence of DISH in patients with cervical myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) or cervical spondylosis and to compare sagittal alignment of the spine between patients with and without DISH.

Methods

A total of 103 consecutive patients with a diagnosis of cervical myelopathy due to cervical OPLL or spondylosis were retrospectively enrolled in this single-center study. DISH was defined as an ossified lesion that was seen to be completely bridging at least four contiguous adjacent vertebral bodies in the thoracic spine on computed tomography scans. Cervical and spinopelvic sagittal parameters were measured in whole spine radiographs.

Results

The study population included 28 cases with DISH [DISH (+) group] and 75 without DISH [DISH (−) group]. OPLL was more prevalent in the DISH (+) group than in the DISH (−) group; however, there were no significant differences in other clinical findings. Propensity score matching produced 26 pairs. C7 slope, C2-7 sagittal vertical axis (C-SVA), whole thoracic kyphotic angles, upper thoracic kyphosis, and T5-T12 thoracic kyphosis values were significant higher in the DISH (+) group than in the DISH (−) group. There was no significant between-group difference in the other sagittal spinopelvic parameters.

Conclusions

This study is the first to compare sagittal alignment in patients with cervical myelopathy according to whether or not they have DISH. Patients with DISH are more likely to have excessive kyphosis in the thoracic spine, a high C7 slope, and a high C2-7 SVA.

Associations between Clinical Findings and Severity of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Ossification of the Posterior Longitudinal Ligament

BACKGROUND

This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear.

METHODS

Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3-10 and C6-T2 and/or T11-L2; and 3, DISH beyond the C5 and/or L3 levels.

RESULTS

DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL.

CONCLUSION

This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.

Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.

Skeletal Fluorosis With Thoracic Myelopathy: A Report of 2 Cases

BACKGROUND

To report 2 different presentations of thoracic myelopathy with ossification of ligamantum flavum (OLF) due to fluorosis.

METHODS

Two females presented with thoracic myelopathy secondary to spinal stenosis with OLF due to fluorosis. On examination, the first patient had a grade 4 power in both lower limbs with altered sensation below L1 dermatome. She had segmental OLF on magnetic resonance imaging and computed tomography and was treated with posterior thoracic laminectomy and recovered well. The second patient had a history of a prior thoracic laminectomy at another institution and presented with paraplegia with bladder involvement. Radiological investigations revealed a 3-column injury at the level of D8/D9. This patient was treated with decompression and stabilization.

RESULTS

The first patient recovered neurologically and regained independent ambulation while the second patient had a reduction in spasticity but no recovery of power or bladder function.

CONCLUSION

Different presentations and causes of myelopathy due to OLF should be recognized and treated. An unstable injury is very rare and should not be missed.

Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture

After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical 'Awareness Criteria' (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.