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Funayama T, Fujii K, Abe T, Kumagai H, Nagashima K, Miura K, Noguchi H, Mataki K, Shibao Y, Koda M, Yamazaki M. Spontaneous symptomatic lumbar intervertebral pseudoarthrosis associated with diffuse idiopathic skeletal hyperostosis treated with a combined posteroanterior fusion: a case report and review of literature. J Spine Surg 2020; 6:626-630. [PMID: 33102901 DOI: 10.21037/jss-20-578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although diffuse idiopathic skeletal hyperostosis (DISH) is generally asymptomatic, in rare cases it involves multiple segments and can present with intervertebral pseudoarthrosis which requires treatment. We report a case of a 47-year-old female patient with intervertebral pseudoarthrosis and severe dynamic instability in the L4-5 intervertebral disc due to DISH and provide a brief review of literature. The patient developed severe lower back pain and intermittent claudication due to the instability in the only mobile part between multiple fused vertebrae from C7 to L4 and fusion segment from L5 to the ilium. We performed long-range posterior spinal and two-stage 360° fusion with L4-5 lateral interbody fusion. After the surgery the pain and intermittent claudication were improved and bony fusion was successful. Reports of intervertebral pseudoarthrosis in DISH with no history of trauma are extremely rare. We have only been able to find 5 cases. Compared to the previous reports, the present case describes a youngest patient, first case of female, and had the longest fusion due to DISH. Therefore, the patient required long-range fusion from T10 to the iliac bone in order to achieve adequate stabilization. Moreover, the present case is the first example of choosing a lateral interbody fusion, which provides even more robust consolidation.
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Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kentaro Mataki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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