DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS OF THE CERVICAL SPINE - DIAGNOSIS, TREATMENT

Диффузный идиопатический скелетный гиперостоз - системное состояние, характеризующееся наличием по меньшей мере трех костных мостиков в переднебоковом отделе позвоночника. Распространенность заболевания составляет 2,9% - 42,0%. Важным компонентом для диагностики гиперостоза было наличие костного нароста в передней части смежных позвонков. Дебют диффузного идиопатического скелетного гиперостоза протекает бессимптомно, в результате чего заболевание обнаруживается как случайное открытие во время рентгенологического обследования других заболеваний. Клинически значимым симптомом гиперостоза в шейном отделе является дисфагия и обструкция дыхательных путей. В результате костного нароста, расположенного кпереди от тел позвонков в шейном отделе позвоночника, трахея и пищевод смещаются, что приводит к дисфагии и обструкции дыхательных путей, что является главным диагностическим критерием и показанием к оперативному лечению. Diffuse idiopathic skeletal hyperostosis is a systemic condition characterized by the presence of at least three bone bridges in the anterolateral spine. The prevalence of the disease is 2.9% - 42.0%. An important component for the diagnosis of hyperostosis was the presence of a bone growth in the anterior part of the adjacent vertebrae. The onset of diffuse idiopathic skeletal hyperostosis is asymptomatic, as a result of which the disease is detected as an accidental discovery during X-ray examination of other diseases. A clinically significant symptom of cervical hyperostosis is dysphagia and airway obstruction. As a result of the bone growth located anteriorly from the vertebral bodies in the cervical spine, the trachea and esophagus are displaced, which leads to dysphagia and airway obstruction, which is the main diagnostic criterion and indication for surgical treatment.

Case Report: Identifying Andersson-Like Lesions in Diffuse Idiopathic Skeletal Hyperostosis

Andersson lesions (ALs) in ankylosing spondylitis (AS) pose a severe risk to the stability of ankylosed spine, which might result in significant deterioration of spinal cord function after traumatic or inflammatory causes. Herein, erosive discovertebral lesions in diffuse idiopathic skeletal hyperostosis (DISH) presented important clinical similarities to AL in AS, but failed to completely recognize unstable spinal lesions. Therefore, we pioneered to identify spinal discovertebral lesions similar to Andersson-like lesions (ALLs) in DISH, followed by the characterization and summarization of the etiology, radiology, laboratory results, clinical symptoms, and treatment strategies for AL in AS with ALL in DISH. By characterizing the ALL in DISH cases, we showed that the ALL was mainly traumatic and established at the junction of focal stress between two adjacent ossified level arms. Erosive discovertebral ALLs were formed after trivial stress of direct impact and could be subdivided into transdiscal, transvertebral, and discovertebral types radiologically. Patients who presented with ALL frequently suffered from consistent back pain clinically and experienced a decrease in motion ability that could reflect skeletal stability, which received treatment effectiveness after conservative external spinal immobilization or further surgical internal fixation, indicating the significance of recognizing ALL in the ankylosed DISH spine to further maintain spinal stability in order to prevent catastrophic neurologic sequelae. Our work highlighted the clinical relevance of ALL in DISH in comparison with AL in AS, which provided broader insight to identify ALL in DISH, thus facilitating early intervention against DISH deterioration.

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.